title: Pain adversely affects outcomes to a collaborative care intervention for anxiety in primary care.
abstract: BACKGROUND
  Primary care patients with Panic Disorder (PD) and Generalized Anxiety Disorder (GAD) experience poorer than expected clinical outcomes, despite the availability of efficacious pharmacologic and non-pharmacologic treatments. A barrier to recovery from PD/GAD may be the co-occurrence of pain.
  
  
  OBJECTIVE
  To evaluate whether pain intensity interfered with treatment response for PD and/or GAD in primary care patients who had received collaborative care for anxiety disorders.
  
  
  METHODS
  A secondary data analysis of a randomized, controlled effectiveness trial comparing a telephone-delivered collaborative care intervention for primary care patients with severe PD and/or GAD to their doctor's "usual" care.
  
  
  METHODS
  Patients had to have a diagnosis of PD and/or GAD and a severe level of anxiety symptoms. The 124 patients randomized at baseline to the collaborative care intervention were analyzed. Participants were divided into two pain intensity groups based on their response to the SF-36 Bodily Pain scale (none or mild pain vs. at least moderate pain).
  
  
  METHODS
  Pain was assessed using the Bodily Pain scale of the SF-36. Anxiety symptoms were measured with the Hamilton Anxiety Rating Scale (HRS-A), Panic Disorder Severity Scale (PDSS) and Generalized Anxiety Disorder Severity Scale (GADSS). Measures were collected over 12 months.
  
  
  RESULTS
  At baseline, patients with at least moderate pain were significantly more likely to endorse more anxiety symptoms on the HRS-A than patients with no pain or mild pain (P < .001). Among patients with severe anxiety symptoms, 65 % (80/124) endorsed experiencing at least moderate pain in the previous month. A significantly lesser number of patients achieved a 50 % improvement at 12 months on the HRS-A and GADSS if they had at least moderate pain as compared to patients with little or no pain (P = 0.01 and P = 0.04, respectively).
  
  
  CONCLUSIONS
  Coexisting pain was common in a sample of primary care patients with severe PD/GAD, and appeared to negatively affect response to anxiety treatment.
authors.affiliation: Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA 15213, USA. moronene@upmc.edu
authors.forename: Natalia E
authors.initials: NE
authors.lastname: Morone
authors.forename: Bea Herbeck
authors.initials: BH
authors.lastname: Belnap
authors.forename: Fanyin
authors.initials: F
authors.lastname: He
authors.forename: Sati
authors.initials: S
authors.lastname: Mazumdar
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Rollman
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications*; D010147:Pain Measurement / Q000379:methods; D016584:Panic Disorder / Q000150:complications / Q000628:therapy*; D010348:Patient Care Team; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome