Evaluating and treating co-morbid pain and depression

Pain and depression are among the most pervasive conditions to confront a p hysician. In any given year, 10-15% of the adults in the US have some form of work disability owing to back pain alone and pain disorders are estimate d to cost the American health economy over $100 billion annually in healthc are, workers' compensation and lost productivity (Osterweis et al., 1987); Depression is often overlooked or inadequately treated and causes refractor iness to pain treatment (Depression Guideline Panel, 1993). The problem of identifying depression in patients seeking pain treatment challenges all cl inicians. Whether in primary care clinics, where chronic pain first present s, in traditional specialty offices where pain cases are frequently referre d for unproductive and expensive diagnostic and therapeutic procedures, or in pain clinics, which may be the patients' last hope, identifying depressi on must be a high priority. Although most pain disorders begin with injury or disease, their course, outcome and costs are affected by behavioral, soc ial, and economic factors (Gallagher et al., 1989). A patient's emotional r eaction to and capacity to cope with the fluctuating course of a chronic pa in disorder and complications, such as physical impairment, disability and loss of role functioning, will also affect outcome and costs. Depression ma y result from poor outcome of the pain disorder, but depression also magnif ies the negative effects of pain on social and occupational functioning, wh ich worsens outcome (Wells et al., 1988). Early intervention, to help preve nt the complications of chronic depression and its negative effects should be a priority of clinicians from all health cave disciplines.