title: The association of depression with pain-related treatment utilization in patients with multiple sclerosis.
abstract: OBJECTIVE
  To better understand the association of depression with pain treatment utilization in a multiple sclerosis (MS) population.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Community-based survey.
  
  
  METHODS
  Convenience sample of 117 individuals with MS.
  
  
  METHODS
  Participants provided demographic information, descriptive information on utilization of pain treatments, pain intensity ratings on a 0-10 numerical rating scale, and depressive symptoms on the Patient Health Questionnaire-9 (PHQ-9).
  
  
  RESULTS
  Participants reporting clinical levels of depressive symptoms (PHQ-9 ≥10) reported that they tried more pain treatments previously relative to participants with PHQ-9 <10; however, the two groups did not differ in the number of treatments they were currently using. Additionally, participants with PHQ-9 ≥10 had more visits to providers for pain treatment relative to the group with PHQ-9 <10. In subsequent analyses, results showed that these differences were no longer significant after controlling for level of pain intensity.
  
  
  CONCLUSIONS
  The results demonstrate that depression is not associated with higher pain treatment utilization. These findings support the assertion in previous studies that the mechanism by which depression impacts medical utilization is through increased appointments for nonspecific complaints, not for specific medical problems. While this suggests that treating depression may not be helpful in reducing pain treatment utilization specifically, it remains important to treat depression to reduce pain-related suffering and medical utilization more broadly.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98104, USA. kalschul@uw.edu
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Alschuler
authors.forename: Mark P
authors.initials: MP
authors.lastname: Jensen
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Ehde
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology / Q000628:therapy; D059408:Pain Management / Q000706:statistics & numerical data*; D010147:Pain Measurement; D012044:Regression Analysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires