Duloxetine and care management treatment of older adults with comorbid major depressive disorder and chronic low back pain: results of an open‐label pilot study

Abstract

Objective: In older adults, major depressive disorder (MDD) and chronic low back pain (CLBP) are common and mutually exacerbating. We predicted that duloxetine pharmacotherapy and Depression and Pain Care Management (DPCM) would result in (1) significant improvement in MDD and CLBP and (2) significant improvements in health-related quality of life, anxiety, disability, self-efficacy, and sleep quality. Design and Intervention:Twelve week open-label study using duloxetine up to 120 mg/day + DPCM.Setting: Outpatient late-life depression research clinic.Patients: Thirty community-dwelling adults >60 years old. Outcome Measures: Montgomery Asberg Depression Rating Scale (MADRS) and McGill Pain Questionnaire-Short Form (MPQ-SF).Results: 46.7% (n = 14) of the sample had a depression remission. All subjects who met criteria for the depression remission also had a pain response. 93.3% (n = 28) had a significant pain response. Of the subjects who met criteria for a low back pain response, 50% (n = 14) also met criteria for the NIH Public Access Author ManuscriptInt J Geriatr Psychiatry. Author manuscript; available in PMC 2010 June 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript depression remission. The mean time to depression remission was 7.6 (SE = 0.6) weeks. The mean time to pain response was 2.8 (SE = 0.5) weeks. There were significant improvements in mental health-related quality of life, anxiety, sleep quality, somatic complaints, and both self-efficacy for pain management and for coping with symptoms. Physical health-related quality of life, back painrelated disability, and self-efficacy for physical functioning did not improve. Conclusions:Serotonin and norepinephrine reuptake inhibitors like duloxetine delivered with DPCM may be a good choice to treat these linked conditions in older adults. Treatments that target low self-efficacy for physical function and improving disability may further increase response rates.

Adherence to a Community-based Exercise Program Is a Strong Predictor of Improved Back Pain Status in Older Adults

“…Among older adults, there is a bi-directional relationship between low back pain and depressive symptoms as each is a risk factor for the other. (41–43) Karp et al asserted that the relationship between chronic low back pain and depression “can lead to a cycle of demoralization, physical and psychosocial disability, and exacerbated medical and psychiatric comorbidity.”(44) In the presence of both back pain and depressive symptoms, it may be vitally important to address both issues simultaneously to have good outcomes for either problem.…”

Resting state functional connectivity and treatment response in late-life depression

“…The neuroimaging study was embedded in several open-label treatment intervention trials for LLD conducted at the University of Pittsburgh Advanced Center for Intervention and Services Research for Late-Life Mood Disorders (ACISR) from 2004 and 2011 (Karp et al, 2010; Reynolds et al, 2011; Reynolds et al, 2010). Additional description of these trials is provided in the online supplemental data.…”

Combining Opioid and Adrenergic Mechanisms for Chronic Pain

“…59 In older patients with comorbid major depression and CLBP, duloxetine was effective in improving both conditions, with improvements in pain preceding improvements in depression. 60 Past analyses of randomized controlled trials of duloxetine have shown that its effects on pain using a McGill Pain Questionnaire are independent of its antidepressive effects. 58 Recent preclinical series provide some insight into the MOA of duloxetine against neuropathic pain, including its ability to confer antinociceptive effects in mechanical hyperalgesia 61 and interact with serotonin 2A receptors in DPN.…”