An interpersonal psychotherapy approach for treatment of comorbid chronic pain and depression

Abstract

Depression is prevalent among patients with chronic pain, as well as a risk factor for poor pain treatment outcomes. Interpersonal Psychotherapy (IPT) is well-documented as an effective treatment for depression, including among diverse and medically ill populations. While there is substantive evidence supporting the use of cognitive-behavioral therapy for patients with pain, IPT has never been prospectively tested for patients with pain. This study evaluated the feasibility, acceptability and effects of Interpersonal Treatment for Depression and Pain (IPT-P), adapted for patients with chronic pain and depression in primary care. Our primary aim was to determine if there were changes in depressive symptoms, social adjustment, and pain. Seventeen female patients with major depressive disorder and chronic pelvic pain received up to 8 sessions of individual psychotherapy. Participants were recruited from a women's health clinic, were predominantly low-income and minority, and generally did not initially self-identify as depressed or in need of mental health treatment. Patients were assessed at baseline, 12-weeks, 24-weeks, and 36-weeks. Depression was measured with the Beck Depression Inventory and Hamilton Rating Scale for Depression. Pain was measured with the Multidimensional Pain Inventory Interference Scale. Social Adjustment was assessed with the Social Adjustment Scale – Self Report. Most enrolled patients engaged in treatment and reported a high level of satisfaction with IPT-P. Significant improvements were found for depression severity and social adjustment, with effect sizes ranging from .77-1.57. A small effect size of .13 was found for pain interference, which did not change significantly following treatment. This pilot study provides preliminary support for the use of IPT-P for patients with comorbid depression and chronic pain. IPT-P may be a suitable treatment option for non-treatment seeking patients in primary care settings who are receptive to psychotherapy. Additional research is needed with more rigorous, controlled experimental conditions.