Interpersonal psychotherapy for co-occurring depression and chronic pain.

Abstract

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately onefourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans and Latinos all report higher rates of pain and depression compared to other groups. This article describes a version of Interpersonal Psychotherapy tailored for patients with comorbid depression and chronic pain, Interpersonal Psychotherapy for Depression and Pain (IPT-P). While IPT-P potentially could be delivered to many different patient populations in a range of clinical settings, this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non-treatment seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option has the potential to improve clinical outcomes for individuals with depression and chronic pain.

Investigation of the Phase Model of Psychotherapy Across Therapeutic Orientations: Are Different Approaches Actually All That Different?

“…The focus of CT is on symptoms and the thought processes that underlie them (Beck, 2005;Beck, Rush, Shaw & Emery, 1979;Dobson & Khatri, 2000;Kanter, Rusch, Holman, Whiteside, Landes & Sedivy, 2009) and thus may be summarized as being chiefly concerned with the remediation phase of the model. IPT, on the other hand, primarily targets interpersonal conflicts and the processes that underlie relational patterns (Blanco, Clougherty, Lipsitz, Mufson, Weissman, 2006;Evans, 1996;Hoffman-King & Giles, 2010;Klerman, Weissman, Rounsaville & Chevron, 1984;Poleshuck, Gamble, Cort, Cerrito, Rosario-McCabe, Sundberg, 2001;Weissman & Markowitz, 2005), which reflects the rehabilitation phase of the model since this relates to social role functioning and interpersonal distress.…”

“…This treatment protocol is again heavily rooted in the interpersonal model, but with the caveat of recognizing the central role that the client's pain has in perpetuating negative social interactions and interpersonal relationships (Poleshuck et al, 2010). This modification includes integrating pain management techniques, encouraging selfcare and various other aspects of psychotherapy that are often utilized in psychotherapy involving issues of chronic pain.…”

Inflammation and Chronic Pelvic Pain: A Biological Trigger for Depression in Women?

“…While depression can, no doubt, be provoked by psychoemotional factors (personal, relational and/or context-dependent), the identification of the underling biologically-mediated nervous and systemic changes is important to properly manage it [3]. Depression is often associated with local or systemic diseases [4,5]. Peripheral organ inflammation and neuroinflammation can alter neuronal activity both within and outside the brain, thereby contributing to the psychoemotional and somatic symptoms of depression [2,4].…”

“…Depression is often associated with local or systemic diseases [4,5]. Peripheral organ inflammation and neuroinflammation can alter neuronal activity both within and outside the brain, thereby contributing to the psychoemotional and somatic symptoms of depression [2,4].…”

“…This is probably due to the greater vulnerability of women to developing depression as compared to men. Moreover, women are more likely to report emotional distress associated with their pain [4,11]. Further, alterations in pain perception and tolerance to pain were reported in depressed patients not suffering from chronic pain [12].…”