Optimized Antidepressant Therapy and Pain Self-management in Primary Care Patients With Depression and Musculoskeletal Pain

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Abstract
Pain is the most common presenting somatic symptom in medical outpatients,1 and depression is the most common mental disorder.2 Pain complaints account for more than 40% of all symptom-related outpatient visits,3 and depression is present in 10% to 15% of all patients attending primary care. Two-thirds of pain-related outpatient visits are due to musculoskeletal pain, accounting for nearly 70 million outpatient visits in the United States each year.3 Back and joint pain result in an estimated 200 million lost work days per year.4 Moreover, pain and depression frequently coexist (30%-50% co-occurrence) and have an additive effect on adverse health outcomes and treatment responsiveness of one another.5