Results from a recent meta-analysis published in Family Practice reveal small to moderate positive effects from primary care interventions on depressive symptoms and no significant effects on pain.
No consensus exists regarding the optimal treatment approach for comorbidly occurring chronic pain and depression. Researchers sought to quantitatively evaluate the effectiveness of different primary care interventions in treating comorbid chronic pain and depression.
Researchers conducted a systematic literature review and meta-analysis that included randomized controlled trials (RCTs) that included patients with comorbid chronic pain and depression. All RCTs took place in the primary care setting, had baseline and post-intervention outcomes, and lasted at least 8 weeks. The primary outcomes were the intensity and severity of pain and depression symptoms.
A total of 7 RCTs met all inclusion criteria and 893 patients were included in the analysis. Three studies demonstrated significant improvements in both chronic pain and depression outcomes post-intervention, with only 1 of the studies including follow-up data supporting sustained effectiveness. Five studies revealed significant improvement in chronic pain or depression. When aggregating all studies, significant and sustained improvement was found for treating depression; however, the effectiveness of treatment for chronic pain was not significant and decreased from post-intervention to follow up.
Limitations included the small number of trials analyzed coupled with the heterogeneity across the studies. Additionally, studies were from high-income countries and thus results may not be generalizable to lower-income settings.
The researchers concluded, “depression appears more amenable to treatment than pain, but the number of published RCTs assessing both conditions is limited. More research is needed to further develop optimal treatment strategies.”
Patel KH, Chrisinger B. Effectiveness of primary care interventions in conjointly treating comorbid chronic pain and depression: a systematic review and meta-analysis. Fam Pract. Published online August 2, 2023. doi:10.1093/fampra/cmad061