• Soham Rej, Mary Amanda Dew, and Jordan F Karp.
• Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
• Pain Med. 2014 Jul 1; 15 (7): 1154-62.

ObjectiveDepression and chronic low back pain (CLBP) are both frequent and commonly comorbid in older adults seeking primary care. Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine may be effective in treating comorbid depression and CLBP. For patients with comorbid depression and CLBP, our goal was to identify "easy-to-use" early clinical variables associated with response to 6 weeks of low-dose venlafaxine pharmacotherapy that could be used to construct a clinically useful predictive model in future studies.MethodsWe report data from the first 140 patients completing phase 1 of the Addressing Depression and Pain Together clinical trial. Patients aged ≥60 with concurrent depression and CLBP received 6 weeks of open-label venlafaxine 150 mg/day and supportive management. Using univariate and multivariate methods, we examined a variety of clinical predictors and their association with response to both depression and CLBP; change in depression; and change in pain scores at 6 weeks.ResultsAbout 26.4% of patients responded for both depression and pain with venlafaxine. Early improvement in pain at 2 weeks predicted improved response rates (P = 0.027). Similarly, positive changes in depression and pain at 2 weeks independently predicted continued improvement at 6 weeks in depression and pain, respectively (P < 0.001).ConclusionsAn important minority of patients benefitted from 6 weeks of venlafaxine 150 mg/day. Early improvement in depression and pain at 2 weeks may predict continued improvement at week 6. Future studies must examine whether patients who have a poor initial response may benefit from increasing the SNRI dose, switching, or augmenting with other treatments after 2 weeks of pharmacotherapy.Wiley Periodicals, Inc.

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