Treatment of anxiety-depressive disorders in patients with chronic pain
Authors: Sapon Daria 
Published: September 2017

Background
The problem of the treatment of anxiety- depressive disorders in chronic pain is not solved, considering the significant somatization of psychopathological manifestations in dorsalgia and fibromyalgia; triggering and aggravating role of stress; lack of clear clinical recommendations for the management of patients with combined disease states

Methods
164 patients with anxiety-depressive disorders and chronic pain were divided into study group (SG) of 81 persons with fibromyalgia (M79.0) and the comparison group (CG) of 83 persons with joint pain (M25.5) or dorsalgia (M54 .0-9). Both groups were randomized into four groups of therapy: SG-PF (psychopharmatherapy - 42 persons), the SG-PT (psychotherapy - 39 persons) CG-PF (psychopharmatherapy - 45 persons) and CG-PT (psychotherapy - 38 persons).
Psychopharmatherapy held SSRIs, SNRI and pregabalin in standard dosages according to the instructions. Psychotherapeutic interventions involved the following methods: psyhoeducation, muscle relaxation by Jacobson, rational therapy, art therapy, elements of cognitive behavioral therapy. Evaluating the effectiveness of the treatment was carried out after 4 and 12 weeks with Hamilton anxiety and depression scales (HAM-A i HAM-D).

Results
After 4 weeks of treatment the most significant reduction in anxiety symptoms occurred psychopharmatherapy groups, namely (SG-PF HAM-A 15,1 ± 2,3; to CG-PF HAM-A 15,4 ± 2,2).
After 12 weeks, the most significant reduction in anxiety symptoms was in group SG-PA (HAM-A 8,2 ± 1,6), and the lowest one - in group SG-PF (HAM-A 9,7 ± 1,7). No one group has not achieved remission (HAM-A> 7). There was significant difference in reduction of HAM-A between the SG-PF and CG-PF in the short-term intervention (p = 0.008) and for the entire treatment period (p = 0.033). From the second month of therapy was significantly better dynamics of anxiety reduction in group SG-PT compared to CG-PT (p = 0.045), which influenced the end of treatment (p = 0.036)
After 4 weeks of treatment the most significant reduction of depressive symptoms was in group SG-PF (HAM-D 12,7 ± 2,1). In group SG after 12 weeks of treatment was the most significant reduction of depression: SG-PF HAM-D 3,1 ± 1,4; SG-PT - HAM-D 3,4 ± 1,6. In SG grour was credible proactive impact on the reduction of depression pharmacotherapy for the first 4 weeks of treatment (p = 0.048), similar to the reduction of anxiety. More intensive psychotherapy in effect on depression symptoms in group SG repeating pattern of anxiety symptoms has been between 4 to 12 week (p = 0.016).

Conclusion
In the short-term treatment of anxiety-depressive disorders in patients with chronic pain psychopharmatherapy was more effective, while long treatment - psychotherapy. This pattern was most stable in patients with fibromyalgia, with greater reduction of anxiety symptoms relative to comparison with the symptoms of depression. Patients with fibromyalgia were sensitive to both therapies. The combination of psychotherapy and psychopharmatherapy increases the overall efficiency of the treatment.