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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThis randomized trial was designed to compare the efficacy of venlafaxine with supportive management with venlafaxine with problem-solving therapy in older patients with comorbid chronic low back pain and depression. Although both treatment options improved pain and depression scores, problem-solving therapy provided no additional benefit.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Evenlafaxine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esupportive management\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eproblem-solving therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Echronic low back pain\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edepression\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emood disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epsychiatry \u0026amp; psychology clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EJordan F. Karp, MD, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA, presented data from the ADAPT trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01124188\u0026amp;atom=%2Fspmdc%2F15%2F11%2F9.atom\u0022\u003ENCT01124188\u003C\/a\u003E], which demonstrated that venlafaxine with supportive management (SM) led to significant response rates, especially for pain, in older adults with depression and chronic low back pain (CLBP). However, there was no additional benefit of problem-solving therapy for depression and pain (PST-DP) in terms of improved response.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAccording to Dr Karp, late-life depression is a significant public health problem that decreases quality of life and survival in affected patients, contributes to a poorer prognosis for comorbid conditions, and is a risk factor for suicide. In addition, it is associated with increased health care utilization and costs. He noted that, when treating older adults, late-life treatment-resistant depression is the rule, not the exception. In the United States and Canada, 25% to 50% of older adults in community settings and 49% to 83% in nursing homes suffer chronic pain, reported Dr Karp. Anxiety and depression are also more common in these patients than in those without pain, and the pain can lead to memory and cognition problems. CLBP in particular has a prevalence of 12% in the community, and it is the most common referral to pain clinics.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe ADAPT study was therefore conducted to compare high-dose venlafaxine with PST-DP with high-dose venlafaxine with SM in older adults living with CLBP and depression. Inclusion criteria were men and women aged \u0026gt;\u200560 years experiencing CLBP and low mood. Primary outcomes were measures of depression, pain, and disability.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ETwo hundred and twenty-seven patients with comorbid depression and CLBP started the trial. In the first phase, all participants received 150 mg\/d of venlafaxine for 6 weeks and SM. Phase 1 nonresponders had a higher medical burden than responders, said Dr Karp. They had more severe depression (Patient Health Questionnaire-9 [PHQ-9] score 16.5 vs 14.3; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.004), more treatment-resistant depression (as measured by the Antidepressant Treatment History Form; 55.3% vs 18.4%; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0002), greater pain extensity (as demonstrated by the number of painful areas on a pain map; 13.5 vs 9.2; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.01), and more pain-related functional disability (Roland Morris Disability Questionnaire score 15.61 vs 12.87; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0007). In phase 1, a 2-week change in the numeric rating scale was the only significant predictor of improvement in depression and pain.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EPatients who responded poorly during phase 1 went on to the second intervention phase, while those who responded well were excluded. Patients received up to 300 mg\/d (median dose 244 mg) of venlafaxine for 14 weeks and were randomized to also receive either SM or PST-DP (an average of 8 to 9 sessions). Response during phase 2 was characterized by 2 sequential visits of PHQ-9 \u2264\u20055 and \u2265\u200530% reduction in the numeric rating scale.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe results in phase 2 demonstrated a 40% response rate in depression and pain at any point during the study (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/9\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Response Rate in Phase 2 of the ADAPT StudyCohorts A and B represent the 2 cohorts in the second phase of the study (cohorts remain blinded at this time).Reproduced with permission from JF Karp, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-775687408\u0022 data-figure-caption=\u0022Response Rate in Phase 2 of the ADAPT StudyCohorts A and B represent the 2 cohorts in the second phase of the study (cohorts remain blinded at this time).Reproduced with permission from JF Karp, MD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/9\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/9\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/9\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16876\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EResponse Rate in Phase 2 of the ADAPT Study\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ECohorts A and B represent the 2 cohorts in the second phase of the study (cohorts remain blinded at this time).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EReproduced with permission from JF Karp, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EAlthough there was no additional benefit of PST-DP in terms of improved response, patient follow-up will continue for 12 months to investigate whether PST-DP decreases the rate of relapse and health care utilization, Dr Karp concluded.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/11\/9.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlige\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlige\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}