Journal of General Internal Medicine

, Volume 28, Issue 1, pp 58–66 | Cite as

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

  • Natalia E. Morone
  • Bea Herbeck Belnap
  • Fanyin He
  • Sati Mazumdar
  • Debra K. Weiner
  • Bruce L. Rollman
Original Research



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.


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.


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.


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).


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.


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).


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


panic disorder generalized anxiety disorder pain collaborative care clinical trial 



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.


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Natalia E. Morone
    • 1
    • 2
    • 7
  • Bea Herbeck Belnap
    • 1
    • 7
  • Fanyin He
    • 3
  • Sati Mazumdar
    • 3
  • Debra K. Weiner
    • 2
    • 4
    • 5
    • 6
    • 7
  • Bruce L. Rollman
    • 1
    • 7
  1. 1.Division of General Internal Medicine, Center for Research on Health CareUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare SystemPittsburghUSA
  3. 3.Department of BiostatisticsUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  4. 4.Division of GeriatricsUniversity of Pittsburgh School of MedicinePittsburghUSA
  5. 5.Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghUSA
  6. 6.Department of AnesthesiologyUniversity of Pittsburgh School of MedicinePittsburghUSA
  7. 7.Clinical and Translational Sciences InstituteUniversity of Pittsburgh School of MedicinePittsburghUSA

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