A Behavioral Intervention for Depression and Chronic Pain in Primary Care

Chronic pain and depression frequently co-exist in late and mid-life and contribute to
increased disability, high health care costs, psychiatric comorbidity, and suicide. Older and
middle-aged depressed-pain patients: a) are mainly treated in primary care practices; and b)
are often prescribed medication, which increases the risk for addiction to opioids and
benzodiazepines. Despite the need - and desire by the patients and providers - for primary
care behavioral intervention, behavioral interventions are scarce in primary care. To address
this need, the investigators worked with primary care practices of the Weill Cornell Medical
Associates (WCMA), and developed Relief, a 9-session behavioral intervention, designed to be
administered by licensed social workers (LCSWs) and/or nurse practitioners (NP) in primary
care practices.

The investigators will recruit 60 adults (50+ years old), from two randomly assigned large
WCMA primary care practices that screen all patients for depression with the PHQ-9. One
practice will offer Relief (N=40) and one will offer referral (based on clinical indication)
for mental health care (N=20), provided at the practice site. Participants will have
clinically significant depression (PHQ-9 ≥10) and suffer from pain (during most days for ≥ 3
months). To facilitate future implementation studies, WCMA LCSWs and NPs will administer
Relief. Assessments will be conducted at entry, and at 6, 9, & 12 weeks.

Inclusion Criteria:

1. Age 50 years

2. PHQ-9 greater than or equal to 10; this cut-off represents depression of moderate
severity and has a sensitivity of 88% and a specificity of 88% for major depression.
Thus, most participants are expected to have a DSM-5 depression diagnosis. In
addition, PHQ-9 scores have a significant positive association with pain-related
disability assessed with SF-20

3. Non-cancer related chronic pain, defined as pain during most days over the past 3
months by patient report

4. Capacity to consent determined by a clinician of the primary care practice.

Exclusion Criteria:

1. DSM-5 Axis 1 other than depression and anxiety disorders

2. Mini Mental State Exam < 24

3. Active suicidal ideation, i.e. MADRS Suicide Item greater than or equal to 4; 4)
Severe or life-threatening medical illness. Patients on psychotropics, opioids or
benzodiazepines will be included if they do not meet DSM-5 criteria for opioid,
anxiolytics or other substance abuse disorders