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.
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.


METHODS
Twelve week open-label study using duloxetine up to 120 mg/day + DPCM.


METHODS
Outpatient late-life depression research clinic.


METHODS
Thirty community-dwelling adults >60 years old.


METHODS
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 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 pain-related 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.
Karp
Jordan F
JF
Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. karpjf@upmc.edu
Weiner
Debra K
DK
Dew
Mary A
MA
Begley
Amy
A
Miller
Mark D
MD
Reynolds
Charles F
CF
D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004185:Disability Evaluation; D019468:Disease Management; D000068736:Duloxetine Hydrochloride; D005260:Female; D006304:Health Status; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000523:psychology; D008297:Male; D010147:Pain Measurement; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D020377:Self Efficacy; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012890:Sleep; D011795:Surveys and Questionnaires; D013876:Thiophenes / Q000627:therapeutic use*
D000068736:Duloxetine Hydrochloride; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes