Depression Among Chronic Pain Patients: Cognitive-Behavioral Analysis and Effect on Rehabilitation Outcome

This study addressed two issues concerning the theoretical and clinical relevance of depression to chronic pain: (a) whether reliable differences among depressed, mildly depressed, and nondepressed chronic pain patients could be identified and (b) whether depression influenced participation in or outcome following a rehabilitation program. To address the first issue, four theoretical constructs (pain severity, support from significant others, instrumental activities, and coping skills) were measured by multiple scales. Multivariate analyses of each construct revealed significant differences between the three groups on instrumental activities and coping skills, with more depressed individuals reporting lower levels of functioning. There was a tendency for depressed individuals to report less support. An analysis of the second issue revealed that depressed pain patients showed a greater tendency to drop out of treatment. Outcome did not vary with depression among treatment completers. The results reveal the need to consider a cognitive-behavioral model of depression secondary to chronic pain.