Combined Interventions for Treating Depression and Chronic Back Pain

The relationship between depression and back pain is complex. Depression is the most common
mental condition associated with chronic back pain. Despite this relationship, many patients
with depression and back pain seek treatment only for one of the two conditions, which can
worsen the untreated condition. An intervention that reduces the symptoms of both depression
and back pain is needed. This study will determine the effectiveness of an integrated
intervention in reducing both back pain and depression symptoms.

Participants will be randomly assigned to receive either an integrated intervention or
standard of care for 6 months. Participants in the integrated intervention group will receive
cognitive behavioral therapy for back pain and antidepressants and/or problem solving therapy
for depression. Study visits will initially occur once a week and then taper to once every 2
weeks for the 6-month duration; the time of tapering will depend on participant response to
treatment and will be at the investigator's discretion. Depression and back pain symptoms
will be assessed in all participants at study entry, at the end of treatment, and 6 months
after the end of treatment. The study entry and study completion assessments will occur
during study visits. The last assessment will be a telephone interview.

Inclusion Criteria:

- Roland back pain score of 7 or greater

- Diagnosis of major depression

- Plan to stay enrolled in Group Health Cooperative for the duration of the study and 1
year after the study

Exclusion Criteria:

- Prior surgery

- Cauda equina syndrome (compression and paralysis of nerve roots)

- Schizophrenia or bipolar disorder treatment within 2 years prior to study entry

- Current or prior psychiatric or psychological care for back pain or depression

- At high risk for suicide