Conducted a research study of older adults with back pain and depression

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Older adults with chronic low back pain and depression will participate in the final year of a five-year study designed to determine whether medication alone or medication combined with health coaching and learning new problem-solving skills is the best treatment for both conditions.The ADAPT (Addressing Depression and Pain Together) study is an initiative led by researchers at the University of Pittsburgh School of Medicine.

Low back pain and clinical depression are common in older adults, with up to 25% of older adults suffering from both conditions at the same time, said principal investigator Jordan F. Karp, M.D., associate professor of psychiatry at the University of Pittsburgh School of Medicine.

Chronic low back pain and depression exacerbate each other, have similar risk factors, and increase the likelihood of recurrence. ‘Both cause sleep deprivation and associated daytime sleepiness, which can prevent patients from participating in and enjoying their usual activities and isolate them from the rest of the household. Combined, the two can create a vicious cycle of depression, pain, poor physical functioning, and feelings of hopelessness.

In the ADAPT trial, adults over the age of 60 who have been experiencing depression and back pain on most days for at least three months will participate in the first phase, all of whom will take the antidepressant medication venlafaxine (also known as Effexor) during that time. Participants who show no improvement in the first 6 weeks will be given the opportunity to continue in the study for an additional 14 weeks, either on a higher dose of venlafaxine alone or taught problem-solving skills to manage pain, mood, sleep, and other difficulties commonly experienced by older adults with these related disorders Randomized to receive it in combination with a counseling program.

At low doses, venlafaxine increases levels of the mood-regulating neurotransmitter serotonin. At higher doses, it also increases levels of norepinephrine, a neurotransmitter that regulates both mood and pain, Dr. Karp said.

Venlafaxine is a widely used and well-tolerated drug approved for the treatment of anxiety and depression. Moving people through healthy behavior change and better pain control may improve their mood and quality of life.”

According to Dr. Karp, the purpose of this study is to learn if people who do not improve on low-dose venlafaxine alone need to add problem-solving therapy to feel better.

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