title: Physician speciality and pain reduction in patients with depressive symptoms under treatment with venlafaxine.
abstract: OBJECTIVE
  Excessive pain perception may lead to unnecessary diagnostic testing or invasive procedures resulting in iatrogenic complications and prolonged disability. Naturalistic studies on patients with chronic pain and depressive symptoms investigating the impact of medical speciality on treatment outcome in a primary care setting are lacking.
  
  
  METHODS
  In this observational study, we examined whether the magnitude of pain reduction in 444 patients with depressive symptomatology under venlafaxine would relate differently to the medical speciality of the 122 treating physicians, namely psychiatrists (n=110 patients), general practitioners (n=236 patients), and internists (n=98 patients).
  
  
  RESULTS
  Independent of age, gender, patient's region of origin, comorbidity, severity and duration of pain, and depressive symptoms at study entry, patients seemed to benefit significantly less in terms of pain reduction (p<0.001) and of reduction in severity of depressive symptomatology by psychiatrists as compared to general practitioners (p<0.019) and internists (p<0.002).
  
  
  CONCLUSIONS
  The findings suggest that patients referred to psychiatrists are more difficult to treat than those referred to general practitioners and internists, and might not have been adequately prepared for psychiatric interventions. A supporting cooperation and networking between psychiatrists and primary care physicians may contribute to an integrated treatment concept and therefore, may lead to a better outcome in this challenging patient group.
authors.affiliation: Department of General Internal Medicine, Division of Psychosomatic Medicine, University Hospital/Inselspital, 3010 Bern, Switzerland. stefan.begre@insel.ch
authors.forename: S
authors.initials: S
authors.lastname: Begré
authors.forename: M
authors.initials: M
authors.lastname: Traber
authors.forename: M
authors.initials: M
authors.lastname: Gerber
authors.forename: R
authors.initials: R
authors.lastname: von Känel
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000704:Analysis of Variance; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D003511:Cyclohexanols / Q000627:therapeutic use*; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000188:drug therapy*; D010147:Pain Measurement; D058748:Pain Perception; D010820:Physicians; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
chemical_list: D000700:Analgesics; D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D000069470:Venlafaxine Hydrochloride