Abstract

AIN IS THE MOST COMMON PREsenting somatic symptom in medical outpatients, 1 and depression is the most common mental disorder. 2Pain 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.Twothirds of pain-related outpatient visits are due to musculoskeletal pain, accounting for nearly 70 million outpatient visits in the United States each year. 3Back and joint pain result in an estimated 200 million lost work days per year. 4Moreover, pain and depression frequently coexist (30%-50% cooccurrence) and have an additive effect on adverse health outcomes and treatment responsiveness of one another. 5wo types of treatment (one pharmacological and the other behavioral) could prove synergistic in the treatment of comorbid musculoskeletal pain and depression.Antidepressants are a well-established therapy for depression, and there is also evidence for at least moderate efficacy in pain, which may vary by type of painful disorder and antidepressant class. 6,7Pain self-management programs have proven efficacious for both low back pain and osteoarthritis (most commonly located in