Cost-Utility of a Psychoeducational Intervention in Fibromyalgia Patients Compared With Usual Care: An Economic Evaluation Alongside a 12-Month Randomized Controlled Trial.

Cost-Utility of a Psychoeducational Intervention in Fibromyalgia Patients Compared With Usual Care: An Economic Evaluation Alongside a 12-Month Randomized Controlled Trial.

Filed under: Depression Treatment

Clin J Pain. 2013 Jan 16;
Luciano JV, Sabes-Figuera R, Cardeñosa E, T Peñarrubia-María M, Fernández-Vergel R, García-Campayo J, Knapp M, Serrano-Blanco A

OBJECTIVE:: To determine the effectiveness of adding psychoeducational treatment implemented in general practice to usual care for patients with fibromyalgia (FM), and to analyze the cost-utility of the intervention from health care and societal perspectives. METHODS:: Twelve-month randomized controlled trial. A total of 216 primary care patients meeting the American College of Rheumatology criteria for FM participated in the study. The intervention included 9, 2-hour sessions of psychoeducation (5 sessions of education about the illness+4 sessions of autogenic relaxation) added to usual care provided by a multidisciplinary group in general practice was compared to usual care in the public health system. RESULTS:: At 12-month follow-up, patients who received psychoeducation showed greater improvement in global functional status (Cohen d=0.36; -2.49 to 3.81), physical functioning (Cohen d=0.56; 0.08 to 1.00), days feeling well (Cohen d=0.40; -0.16 to 1.02), pain (Cohen d= 0.35; -0.04 to 0.80), morning fatigue (Cohen d=0.24; -0.20 to 0.76), stiffness (Cohen d=0.34; -0.10 to 0.87), and depression (Cohen d=0.30; -0.26 to 0.93). Mean incremental cost per person receiving the intervention was &OV0556;-215.49 (-615.13 to 287.81) from the health care perspective, and &OV0556;-197.32 (-785.12 to 395.74) from the societal perspective. The incremental gain in quality-adjusted life-years per person was 0.12 (0.06 to 0.19), yielding a “dominant” intervention from both perspectives. The sensitivity analysis suggested that the intervention was cost-effective even imputing all missing data. DISCUSSION:: Our findings demonstrate the long-term clinical effectiveness of a psychoeducational treatment program for FM implemented at primary care level and the cost-utility from a health care and societal perspective. TRIAL REGISTRATION:: NCT00550966.
HubMed – depression

Correlation Between Depressive Symptoms and Perioperative Pain: A Prospective Cohort Study of Patients Undergoing Orthopedic Surgeries.

Filed under: Depression Treatment

Clin J Pain. 2013 Jan 16;
Goebel S, Steinert A, Vierheilig C, Faller H

OBJECTIVES:: In previous research a close link between depression and postoperative pain has been described. However, the direction of impact remains unclear. The present longitudinal study aimed to clarify the prognostic value of depressive symptoms for perioperative pain and to explore the causal nature of the association between depressive symptoms and perioperative pain. METHODS:: In this prospective cohort study, 200 patients scheduled for orthopedic surgery were enrolled. They were evaluated preoperatively (T1) and on the second postoperative day (T2) and on the day of discharge (T3). Perioperative pain was monitored using a visual analogue scale-based pain assessment protocol, and depressive symptoms were measured with the self-reported Patient Health Questionnaire. Cross-lagged multiple regression analyses were performed without and with adjusting for possible confounders (sex, American Society of Anesthesiologists physical status, type of surgery, type of anesthesia). RESULTS:: We found significant and substantial links between depressive symptoms and perioperative pain, within a time point and across time intervals, showing consistency with a model of reciprocal impact of depressive symptoms and perioperative pain. No causal priority of one factor over the other was evident. However, after adjusting for possible confounders, only depressive symptoms in the early postoperative period (T2) remained predictive for pain at discharge (T3) and preoperative pain (T1) predicted postoperative depressive symptoms at both T2 and T3. CONCLUSIONS:: Our results suggest that early postoperative depressive symptoms predicts pain at discharge and preoperative pain predicts postoperative depressive symptoms. In conclusion, perioperative pain therapy should include the treatment of both, pain and depressive symptoms, to achieve sufficient pain relief. The evidence regarding the causal relationships between depressive symptoms and perioperative pain, however, must be tested in future research.
HubMed – depression

Cognitive behavioral therapy for depression changes medial prefrontal and ventral anterior cingulate cortex activity associated with self-referential processing.

Filed under: Depression Treatment

Soc Cogn Affect Neurosci. 2013 Jan 17;
Yoshimura S, Okamoto Y, Onoda K, Matsunaga M, Okada G, Kunisato Y, Yoshino A, Ueda K, Suzuki SI, Yamawaki S

Cognitive behavioral therapy (CBT), an effective treatment for depression, targets self-referential processing of emotional stimuli. We examined the effects of CBT on brain functioning during self-referential processing in depressive patients using functional magnetic resonance imaging (fMRI). Depressive patients (n=23) and healthy participants (n=15) underwent fMRI scans during a self-referential task using emotional trait words. The depressive patients had fMRI scans before and after completing a total of 12 weekly sessions of group CBT for depression, whereas the healthy participants underwent fMRI scans 12 weeks apart with no intervention. Before undergoing CBT, the depressive patients showed hyperactivity in the medial prefrontal cortex (MPFC) during self-referential processing of negative words. Following CBT, MPFC and ventral anterior cingulate cortex (vACC) activity during self-referential processing among depressive patients was increased for positive stimuli while it was decreased for negative stimuli. Improvements in depressive symptoms were negatively correlated with vACC activity during self-referential processing of negative stimuli. These results suggest that CBT-related improvements in depressive symptoms are associated with changes in MPFC and vACC activation during self-referential processing of emotional stimuli.
HubMed – depression

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