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Pain Adversely Affects Outcomes to a Collaborative Care Intervention for Anxiety in Primary Care

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ABSTRACT

BACKGROUND

Primary care patients with Panic Disorder (PD) and Generalized Anxiety Disorder (GAD) experience poorer than expected clinical outcomes, despite the availability of efficacious pharmacologic and non-pharmacologic treatments. A barrier to recovery from PD/GAD may be the co-occurrence of pain.

OBJECTIVE

To evaluate whether pain intensity interfered with treatment response for PD and/or GAD in primary care patients who had received collaborative care for anxiety disorders.

DESIGN

A secondary data analysis of a randomized, controlled effectiveness trial comparing a telephone-delivered collaborative care intervention for primary care patients with severe PD and/or GAD to their doctor’s “usual” care.

PARTICIPANTS

Patients had to have a diagnosis of PD and/or GAD and a severe level of anxiety symptoms. The 124 patients randomized at baseline to the collaborative care intervention were analyzed. Participants were divided into two pain intensity groups based on their response to the SF-36 Bodily Pain scale (none or mild pain vs. at least moderate pain).

MAIN MEASURES

Pain was assessed using the Bodily Pain scale of the SF-36. Anxiety symptoms were measured with the Hamilton Anxiety Rating Scale (HRS-A), Panic Disorder Severity Scale (PDSS) and Generalized Anxiety Disorder Severity Scale (GADSS). Measures were collected over 12 months.

KEY RESULTS

At baseline, patients with at least moderate pain were significantly more likely to endorse more anxiety symptoms on the HRS-A than patients with no pain or mild pain (P < .001). Among patients with severe anxiety symptoms, 65 % (80/124) endorsed experiencing at least moderate pain in the previous month. A significantly lesser number of patients achieved a 50 % improvement at 12 months on the HRS-A and GADSS if they had at least moderate pain as compared to patients with little or no pain (P = 0.01 and P = 0.04, respectively).

CONCLUSIONS

Coexisting pain was common in a sample of primary care patients with severe PD/GAD, and appeared to negatively affect response to anxiety treatment.

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Acknowledgments

All work described was supported by a grant from the National Institute of Mental Health (R01 MH59395). The funding source had no role in the design, conduct, or reporting of our study, or in the preparation, review, or decision to submit this manuscript for publication. The contents do not represent the views of the Department of Veterans Affairs or the United States Government.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA

    Natalia E. Morone MD, MS, Bea Herbeck Belnap Dr. Biol. Hum & Bruce L. Rollman MD, MPH

  2. Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Natalia E. Morone MD, MS & Debra K. Weiner MD

  3. Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA

    Fanyin He BS & Sati Mazumdar PhD

  4. Division of Geriatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Debra K. Weiner MD

  5. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Debra K. Weiner MD

  6. Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Debra K. Weiner MD

  7. Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Natalia E. Morone MD, MS, Bea Herbeck Belnap Dr. Biol. Hum, Debra K. Weiner MD & Bruce L. Rollman MD, MPH

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  1. Natalia E. Morone MD, MS
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  2. Bea Herbeck Belnap Dr. Biol. Hum
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Correspondence to Natalia E. Morone MD, MS.

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Morone, N.E., Belnap, B.H., He, F. et al. Pain Adversely Affects Outcomes to a Collaborative Care Intervention for Anxiety in Primary Care. J GEN INTERN MED 28, 58–66 (2013). https://doi.org/10.1007/s11606-012-2186-2

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  • DOI: https://doi.org/10.1007/s11606-012-2186-2

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