• Carrie Farmer Teh, Natalia E Morone, Jordan F Karp, Bea Herbeck Belnap, Fang Zhu, Debra K Weiner, and Bruce L Rollman.
• Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. tehc@upmc.edu
• Depress Anxiety. 2009 Jan 1;26(3):222-8.

BackgroundAnxiety disorders and pain are commonly comorbid, though little is known about the effect of pain on the course and treatment of anxiety.MethodsThis is a secondary analysis of a randomized controlled trial for anxiety treatment in primary care. Participants with panic disorder (PD) and/or generalized anxiety disorder (GAD) (N=191; 81% female, mean age 44) were randomized to either their primary-care physician's usual care or a 12-month course of telephone-based collaborative care. Anxiety severity, pain interference, health-related quality of life, health services use, and employment status were assessed at baseline, and at 2-, 4-, 8-, and 12-month follow-up. We defined response to anxiety treatment as a 40% or greater improvement from baseline on anxiety severity scales at 12-month follow-up.ResultsThe 39% who reported high pain interference at baseline had more severe anxiety (mean SIGH-A score: 21.8 versus 18.0, P<.001), greater limitations in activities of daily living, and more work days missed in the previous month (5.8 versus 4.0 days, P=.01) than those with low pain interference. At 12-month follow-up, high pain interference was associated with a lower likelihood of responding to anxiety treatment (OR=.28; 95% CI=.12-.63) and higher health services use (26.1% with >/=1 hospitalization versus 12.0%, P<.001).ConclusionsPain that interferes with daily activities is prevalent among primary care patients with PD/GAD and associated with more severe anxiety, worse daily functioning, higher health services use, and a lower likelihood of responding to treatment for PD/GAD.(c) 2009 Wiley-Liss, Inc.

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