The presence of anxiety and depression in individuals with chronic low back pain may be associated with higher pain severity and disability, according to a study published in Pain Medicine.

In this prospective cohort study, 284 patients with chronic low back pain at baseline were enrolled (ages 60.4±13.7 years; 74.6% women; n=207 with anxiety; n=165 with depressive symptoms; n=146 with both anxiety and depression). Study participants were undergoing their first consultation for multidisciplinary chronic low back pain.

Investigators used the Hospital Anxiety and Depression Scale to assess symptoms of anxiety and depression and the Shortened Treatment Outcomes in Pain Survey and the Brief Pain Inventory to assess pain outcomes.


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Linear mixed effects models were used to evaluate the effects of interactions between anxiety and depression on treatment outcomes.

Study participants with comorbid anxiety and depression were found to have increased pain severity and pain-related disability (P <.001 for both), and greater emotional disability at the one-year follow-up. The interaction between anxiety and depression was found to be predictive of variations in pain interference in daily life over time.

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“[Anxiety], depression, and their interaction are associated with changes in pain disability at one-year follow-up. These findings encourage the pretreatment screening of anxiety and depression as independent symptoms in patients with [chronic low back pain] in order to design more tailored and effective multidisciplinary treatments,” concluded the study authors.

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Oliveira DS, Mendonça LVF, Sampaio RSM, Dias de Castro-Lopes JMP, Ribeiro de Azevedo LF. The impact of anxiety and depression on the outcomes of chronic low back pain multidisciplinary pain management – A multicenter prospective cohort study in pain clinics with one-year follow-up. [published online July 11, 2018]. Pain Med. doi: 10.1093/pm/pny128