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首页> 外文期刊>General hospital psychiatry >Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study: design and practical implications of an intervention for comorbid pain and depression.
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Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study: design and practical implications of an intervention for comorbid pain and depression.

机译：情感障碍和肌肉骨骼疼痛的分级护理（SCAMP）研究：针对合并症的疼痛和抑郁症的干预措施的设计和实际意义。

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OBJECTIVE: Depression and pain are common comorbid conditions that have reciprocal adverse effects on disability and treatment outcomes. The objective of this article is to describe a study that tests the effectiveness of a stepped-care approach using a combined medication-behavioral intervention. METHOD: Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) is an NIMH-sponsored randomized clinical trial nested within a prospective cohort study. A total of 250 patients with clinically significant depression (PHQ-9 scores > or =10) and musculoskeletal pain of the lower back or legs (hip or knee) and 250 nondepressed patients with similar pain are enrolled, with baseline and serial follow-up assessments to be conducted over 12 months. The depressed patients are randomized to either a stepped-care intervention group or a usual-care control group. Stepped-care patients receive 12 weeks of optimized antidepressant management (Step 1) followed by six sessions of a pain self-management (PSM) program over the next 12 weeks (Step 2), all delivered by a nurse care manager who is supervised by a physician specialist. Approximately two thirds of the care manager contacts are by telephone. RESULTS: The target sample of 500 subjects has been successfully enrolled, and randomization of the depressed patients has resulted in balanced groups of patients with moderately severe pain and depression. Mean SCL-20 depression severity in the clinical trial group is 1.9, with most meeting DSM-IV criteria for major depression (76.3%) and the rest having dysthymia only (18.4%) or minor depression (5.3%). Pain is about equally distributed between lower back (53%) and hip or knee (47%). A rational algorithmic approach to antidepressant selection and dosing, as well as an overview of the PSM program, is provided. CONCLUSIONS: When completed, SCAMP will test whether optimized antidepressant management improves outcomes in patients with comorbid depression and pain and whether PSM produces additional benefits. The findings will be important for both primary care and mental health clinicians confronted by the prevalent depression-pain dyad.
机译：目的：抑郁和疼痛是常见的合并症，会对残疾和治疗结果产生不利的相互影响。本文的目的是描述一项研究，该研究使用联合的药物-行为干预措施来测试阶梯式护理方法的有效性。方法：情感障碍和肌肉骨骼疼痛的阶梯式护理（SCAMP）是一项由NIMH赞助的嵌套在前瞻性队列研究中的随机临床试验。总共入选了250名临床上显着的抑郁症（PHQ-9得分>或= 10）和下背部或小腿（臀部或膝盖）的肌肉骨骼疼痛的患者和250例具有类似疼痛的非抑郁症患者，并进行了基线和连续随访评估将在12个月内进行。抑郁患者被随机分为分步护理干预组或常规护理对照组。逐步护理患者将接受为期12周的优化抗抑郁药管理（步骤1），然后在接下来的12周（步骤2）中进行六个疗程的疼痛自我管理（PSM）程序，所有过程均由护士护理经理提供，并由其监督医生专家。护理经理约有三分之二的电话联系。结果：500名受试者的目标样本已成功入组，抑郁症患者的随机分组导致了中度重度疼痛和抑郁症患者的均衡分组。在临床试验组中，平均SCL-20抑郁严重程度为1.9，其中大多数符合DSM-IV标准的重度抑郁症（76.3％），其余仅具有重度抑郁症（18.4％）或轻度抑郁症（5.3％）。疼痛大约平均分布在下背部（53％）和髋部或膝盖（47％）之间。提供了用于抗抑郁药选择和给药的合理算法方法，以及PSM程序的概述。结论：完成后，SCAMP将测试优化的抗抑郁药治疗是否可改善合并症抑郁和疼痛患者的预后，以及PSM是否产生其他益处。这一发现对于面对普遍存在的抑郁痛双联症的初级保健和精神卫生临床医生而言都是重要的。

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