Pain as a predictorof depression treatment outcomes in women with childhood sexual abuse. Comprehensive Psychiatry, 50, 215-220

Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA.
Comprehensive psychiatry (Impact Factor: 2.25). 05/2009; 50(3):215-20. DOI: 10.1016/j.comppsych.2008.08.001
Source: PubMed

ABSTRACT Childhood sexual abuse (CSA) increases risk for both depression and pain in women. Pain is associated with worse depression treatment response. The contribution of pain to depression treatment outcomes in women with histories of CSA is unknown. This study examined whether clinically significant pain would be associated with worse depression and functioning outcomes among women with CSA histories treated with interpersonal psychotherapy.
Participants were 66 women with major depression and CSA who presented to a community mental health center. An interpersonal psychotherapy protocol planned for 14 weekly sessions followed by 2 biweekly sessions. Patients were classified as experiencing high pain or low pain based on reported pain severity and interference with functioning. Generalized estimating equations were used to assess change over time in intent-to-treat analyses.
High pain patients entered treatment with greater depression symptom severity than low pain patients. Although both high and low pain patients demonstrated improvement in mood, high-pain patients continued to report more depressive symptoms posttreatment. Furthermore, high pain patients demonstrated less change in their emotion-related role functioning over the course of treatment than low pain patients.
Small sample size, secondary analyses, lack of a control group, and limited assessment of pain all limit confidence in the findings of this study.
Findings support the evidence that depression is particularly severe and difficult to treat in patients with CSA and pain. Clinicians should evaluate pain in depressed patients with CSA histories. Role functioning may prove to be a particularly important target in the treatment of patients with pain.

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    • "Frequently, pain patients with psychiatric comorbidities are labeled “difficult patients” by healthcare providers, possibly diminishing the quality of care they will receive. Patients with depression have poorer outcomes for both depression and pain treatments, compared with patients with single diagnoses of pain or depression.54,55 Psychologists are remarkably suited to address most of the psychiatric comorbidities typically encountered in chronic pain populations and thus improve pain treatment outcomes and decrease the emotional suffering of patients. "
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    ABSTRACT: Chronic pain can be best understood from a biopsychosocial perspective through which pain is viewed as a complex, multifaceted experience emerging from the dynamic interplay of a patient's physiological state, thoughts, emotions, behaviors, and sociocultural influences. A biopsychosocial perspective focuses on viewing chronic pain as an illness rather than disease, thus recognizing that it is a subjective experience and that treatment approaches are aimed at the management, rather than the cure, of chronic pain. Current psychological approaches to the management of chronic pain include interventions that aim to achieve increased self-management, behavioral change, and cognitive change rather than directly eliminate the locus of pain. Benefits of including psychological treatments in multidisciplinary approaches to the management of chronic pain include, but are not limited to, increased self-management of pain, improved pain-coping resources, reduced pain-related disability, and reduced emotional distress - improvements that are effected via a variety of effective self-regulatory, behavioral, and cognitive techniques. Through implementation of these changes, psychologists can effectively help patients feel more in command of their pain control and enable them to live as normal a life as possible despite pain. Moreover, the skills learned through psychological interventions empower and enable patients to become active participants in the management of their illness and instill valuable skills that patients can employ throughout their lives.
    Psychology Research and Behavior Management 05/2011; 4:41-9. DOI:10.2147/PRBM.S15375
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    • "Study procedures have been described in detail elsewhere (Poleshuck et al., 2009) and were approved by the University of Rochester Medical Center (URMC) institutional review board. Written informed consent was obtained from all participants, followed by assessments to determine patients' study eligibility. "
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    ABSTRACT: Deterioration in social functioning and depression are often intertwined, particularly for women with histories of childhood sexual abuse (CSA). Among women with CSA histories, some relationship domains may be more modifiable than others during time-limited depression treatment. Women with CSA histories often report long-standing interpersonal difficulties in close relationships. Thus, we expected that patients' relationships with immediate family and intimate partners would be less likely to improve during treatment than relationships with co-workers, friends, or extended family, unless patients received an interpersonally-focused intervention that targeted close relationships. To examine domain-specific social functioning improvements and determine whether some domains were more likely than others to respond to an interpersonally-focused intervention, we analyzed data from a randomized controlled trial investigating Interpersonal Psychotherapy (IPT) vs. usual care (UC) in 69 depressed women with CSA histories. Participants completed the Social Adjustment Scale-SR at pretreatment, 10-, 24-, and 36-weeks. Consistent with our hypotheses, patients reported significant improvements in work roles, leisure activities with friends, and relationships with extended family members over the course of treatment. Relationships with immediate family members and intimate partners did not improve in the overall sample. However, relationships with immediate family improved significantly more among IPT than UC patients. The sample size is small and generalizability may be limited. Social functioning improvements during depression treatment may be domain-specific among depressed women with CSA histories. IPT is more effective than UC at improving relationships with close family members in this population.
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