Chronic Pain Clinical Trial
Official title:
Assessment of a Multicomponent Program for the Integrated Management of Chronic Pain and Depression in Primary Care. Cluster Randomized Clinical Trial
This study evaluates whether the implementation of an integrated clinical program for chronic musculoskeletal pain and depression behave better clinical outcomes than the usual approach in primary care
Chronic musculoskeletal pain and depression are extremely common and relevant pathological
conditions, and frequently presented as comorbid processes multiplying the impact on health,
worsening the prognosis and complicating the care. The integrated management of both
disorders is an opportunity to achieve better clinical outcomes.
AIM: To determinate whether the implementation of an integrated clinical program for chronic
musculoskeletal pain and depression behave better clinical outcomes than the usual approach
in primary care
METHODS
Design: Cluster randomized clinical trials with two arms:
1. Intervention: Integrated program for depression/chronic pain, and
2. control usual care.
Settings: Primary Care Centers in Tarragona, Spain. Patients: Adults with moderate/severe
musculoskeletal pain (Brief Pain Inventory/pain intensity scale > 4 points), with more than
three months of evolution and current diagnostic criteria for major depression episode
(DSM-IV).
Sample: A total sample of 330 patients (165 control arm and 165 intervention arm) divided
into 42 clusters of 8 patients. Cluster composition: patients registered with the same
doctor.
Intervention: Structured program with integrated management for depression/ pain with three
main components:
1. Optimized care of major depression,
2. Case Management, and
3. Group psychoeducational intervention.
Measurements: "Blind" interviews at 0, 3, 6 and 12 months.
Main outcomes:
- Depressive symptoms (Hopkins Symptom Checklist-20): Severity, response rate and
remission rate.
- Pain symptoms (Brief Pain Inventory). Intensity and interference, response rate.
- Disability by psychological problems (Sheehan Disability Inventory)
- Quality of life related to health (EuroQol-5D).
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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