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J Behav Med (2008) 31:301307 DOI 10.1007/s10865-008-9156-5
Self-management practices among primary care patients with musculoskeletal pain and depression
Teresa M. Damush Jingwei Wu Matthew J. Bair Jason M. Sutherland Kurt Kroenke
Accepted: April 23, 2008 / Published online: June 14, 2008 Springer Science+Business Media, LLC 2008
Abstract The objective of this study was to assess the effect of clinical depression on pain self-management practices. We employed a cross-sectional analysis of baseline data from the Stepped Care for Affective disorders and Musculoskeletal Pain (SCAMP) study. Participants included 250 patients with pain and comorbid depression and 250 patients with pain only and were enrolled from urban university and VA primary care clinics. Musculo-skeletal pain was dened as low back, hip or knee pain present C3 months and with at least a moderate, Brief Pain Inventory severity score C5. Depression was dened as a PHQ-9 score C10. We used multiple logistic and Poisson
regression to assess the relationship between individual and combined effects of depression and pain severity on two core pain self-management skills: exercise duration and cognitive strategies. Depressed patients exercised less per week than did nondepressed patients but showed a trend towards more frequent use of cognitive strategies. On multivariable analysis, depression severity substantially decreased the use of exercise as a pain self-management strategy. In contrast, depression and pain severity interacted to increase the use of cognitive strategies. Depression and pain severity have differential effects on self-management practices. Understanding the differences between preferential strategies of pain patients with and without depression may be useful in tailoring pain self-management programs.
Keywords Exercise Cognitive strategies Mental stress relaxation
Musculoskeletal pain is highly prevalent, costly and disabling in the United States (Bigos et al. 1994; Deyo et al. 1991, 2002; Felson et al. 2007; Frymoyer and Cats-Baril 1991; Wipf and Deyo 1995). In a study of veterans visiting primary care, approximately 50% reported experiencing pain symptoms regularly (Barry et al. 2004). Pain is the most common symptom reported in primary care (Kroenke 2003). More specically, musculoskeletal pain accounts for half of all pain complaints of which low back, knee and hip pain are particularly prevalent chronic pain conditions (Parsons et al. 2007). Recently analyses of national data suggests that half of all U.S. adults have low back pain during...