This study will evaluate the effectiveness of a stepped care approach in treating depression
and reducing pain.
In the United States, pain accounts for nearly 20% of all primary health care visits. In the
majority of cases, the pain is musculoskeletal and primarily affects the lower back, hips,
and knees. Studies have shown that at least one-third of patients with pain also suffer from
depression. It has not been determined whether treatments for depression are effective in
patients with comorbid pain and depression. The "Stepped Care for Affective Disorders and
Musculoskeletal Pain" (SCAMP) study will determine the most effective treatment for patients
with pain and depression.
This study will last 12 months and will comprise depressed and nondepressed participants.
Nondepressed participants will receive no treatment. Depressed patients will be randomly
assigned to receive standard of care or stepped care for 12 weeks. Standard of care may
include cognitive therapy, antidepressant treatment, or other treatments. The stepped care
group will receive 12 weeks of antidepressant treatment. Participants who respond to
antidepressant treatment will continue their treatment for the duration of the study.
Participants who do not respond to the treatment after 12 weeks will receive 6 weekly pain
self-management sessions. During these sessions, an educator will teach participants how to
manage their pain through exercise and relaxation techniques. Self-report scales and
questionnaires will be used to assess participants' pain, depressive symptoms, health care
usage and costs, and quality of life. Depressed participants will undergo assessments at
study start and at Months 1, 3, 6, and 12. Nondepressed participants will undergo
assessments at study start and at Months 3 and 12.
Study hypotheses: 1) Stepped care is more effective than usual care in improving depression
and pain. 2) Stepped care is more effective than usual care in improving health-related
quality of life, negative pain beliefs and behaviors, reduced opiate use, and health care
costs. 3) Patients with musculoskeletal pain who are not depressed at baseline will have an
incidence of depression less than 20% over 12 months of follow-up, characteristics that can
be identified as risk factors for incident depression, baseline characteristics
distinguishing them from depressed patients, and better pain and health status outcomes,
compared to depressed patients.
- Moderate or severe pain in the back, hips, or knees for at least 3 months prior to
- History of or current use of at least one medication for pain
- Moderate to severe cognitive impairment
- Schizophrenia or other psychotic disorders
- Receiving disability benefits for pain
- Anticipated life expectancy less than 12 months