The association of depression with pain-related treatment utilization in patients with multiple sclerosis

Abstract

Objective: To better understand the association of depression with pain treatment utilization in a multiple sclerosis (MS) population.

Design: Cross-sectional survey.

Setting: Community-based survey.

Participants: Convenience sample of 117 individuals with MS.

Main outcome measures: Participants provided demographic information, descriptive information on utilization of pain treatments, pain intensity ratings on a 0-10 numerical rating scale, and depressive symptoms on the Patient Health Questionnaire-9 (PHQ-9).

Results: Participants reporting clinical levels of depressive symptoms (PHQ-9 ≥10) reported that they tried more pain treatments previously relative to participants with PHQ-9 <10; however, the two groups did not differ in the number of treatments they were currently using. Additionally, participants with PHQ-9 ≥10 had more visits to providers for pain treatment relative to the group with PHQ-9 <10. In subsequent analyses, results showed that these differences were no longer significant after controlling for level of pain intensity.

Conclusions: The results demonstrate that depression is not associated with higher pain treatment utilization. These findings support the assertion in previous studies that the mechanism by which depression impacts medical utilization is through increased appointments for nonspecific complaints, not for specific medical problems. While this suggests that treating depression may not be helpful in reducing pain treatment utilization specifically, it remains important to treat depression to reduce pain-related suffering and medical utilization more broadly.