Evaluating and treating co-morbid pain and depression

Pain and depression are among the most pervasive conditions to confront a physician. In any given year, 10-15% of the adults in the US have some form of work disability owing to back pain alone and pain disorders are estimated to cost the American health economy over $100 billion annually in healthcare, workers' compensation and lost productivity (Osterweis et al., 1987); Depression is often overlooked or inadequately treated and causes refractoriness to pain treatment (Depression Guideline Panel, 1993). The problem of identifying depression in patients seeking pain treatment challenges all clinicians. Whether in primary care clinics, where chronic pain first presents, in traditional specialty offices where pain cases are frequently referred for unproductive and expensive diagnostic and therapeutic procedures, or in pain clinics, which may be the patients' last hope, identifying depression must be a high priority. Although most pain disorders begin with injury or disease, their course, outcome and costs are affected by behavioral, social, and economic factors (Gallagher et al., 1989). A patient's emotional reaction to and capacity to cope with the fluctuating course of a chronic pain disorder and complications, such as physical impairment, disability and loss of role functioning, will also affect outcome and costs. Depression may result from poor outcome of the pain disorder, but depression also magnifies the negative effects of pain on social and occupational functioning, which worsens outcome (Wells et al., 1988). Early intervention, to help prevent the complications of chronic depression and its negative effects should be a priority of clinicians from all health cave disciplines.