Addressing Both Depression and Pain in Late Life: The Methodology of the ADAPT Study

Jordan F. Karp, Bruce L. Rollman, Charles F. Reynolds, Jennifer Q. Morse, Frank Lotrich, Sati Mazumdar, Natalia Morone, Debra K. Weiner

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Objective. To describe the methodology of the first NIH-funded clinical trial for seniors with comorbid depression and chronic low back pain. Methods. Randomized controlled effectiveness trial using stepped care methodology. Participants are ≥60years old. Phase 1 (6 weeks) is open treatment with venlafaxine xr 150mg/day and supportive management (SM). Response is 2weeks of PHQ-9 ≤5 and at least 30% improvement in the average numeric rating scale for pain. Nonresponders progress to phase 2 (14weeks) in which they are randomized to high-dose venlafaxine xr (up to 300mg/day) with problem solving therapy for depression and pain (PST-DP) or high-dose venlafaxine xr and continued SM. Primary outcomes are the univariate pain and depression response and both observed and self-reported disability. Survival analytic techniques will be used, and the clinical effect size will be estimated with the number needed to treat. We hypothesize that self-efficacy for pain management will mediate response for subjects randomized to venlafaxine xr and PST-DP. Results. Not applicable. Conclusions. The results of this trial will inform the care of these complex patients and further understanding of comorbid pain and depression in late life.

Original languageEnglish (US)
Pages (from-to)405-418
Number of pages14
JournalPain Medicine
Volume13
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

Keywords

  • Back pain
  • Clinical trial
  • Depression
  • Geriatrics
  • Survival analysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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