TY - JOUR
T1 - Pain interference impacts response to treatment for anxiety disorder
AU - Teh, Carrie Farmer
AU - Morone, Natalia E.
AU - Karp, Jordan F.
AU - Belnap, Bea Herbeck
AU - Zhu, Fang
AU - Weiner, Debra K.
AU - Rollman, Bruce L.
PY - 2009/3
Y1 - 2009/3
N2 - Background: Anxiety disorders and pain are commonly comorbid, though little is known about the effect of pain on the course and treatment of anxiety. Methods: This 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. Results: The 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 ofresponding to anxiety treatment (OR =.28; 95% CI =.12-.63) and higher health services use (26.1% with ≥1 hospitalization versus 12.0%, P<.001). Conclusions: Pain 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 ofresponding to treatment for PD/GAD.
AB - Background: Anxiety disorders and pain are commonly comorbid, though little is known about the effect of pain on the course and treatment of anxiety. Methods: This 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. Results: The 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 ofresponding to anxiety treatment (OR =.28; 95% CI =.12-.63) and higher health services use (26.1% with ≥1 hospitalization versus 12.0%, P<.001). Conclusions: Pain 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 ofresponding to treatment for PD/GAD.
KW - Activities of daily living
KW - Anxiety disorders
KW - Pain
KW - Primary care
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U2 - 10.1002/da.20514
DO - 10.1002/da.20514
M3 - Article
C2 - 19133701
AN - SCOPUS:63849180291
SN - 1091-4269
VL - 26
SP - 222
EP - 228
JO - Depression and Anxiety
JF - Depression and Anxiety
IS - 3
ER -