Treating Concurrent Chronic Low Back Pain and Depression with Low‐Dose Venlafaxine: An Initial Identification of “Easy‐to‐Use” Clinical Predictors of Early Response

Objective Depression and chronic l ow back pain ( CLBP ) are both frequent and commonly comorbid in older adults seeking primary care. S erotonin–norepinephrine reuptake inhibitors ( SNRI s) such as venlafaxine may be effective in treating comorbid depression and CLBP . For patients with comorbid depression and CLBP , our goal was to identify “easy‐to‐use” early clinical variables associated with response to 6 weeks of low‐dose venlafaxine pharmacotherapy that could be used to construct a clinically useful predictive model in future studies. Methods We report data from the first 140 patients completing phase 1 of the A ddressing D epression and P ain T ogether clinical trial. Patients aged ≥60 with concurrent depression and CLBP received 6 weeks of open‐label venlafaxine 150 mg/day and supportive management. Using univariate and multivariate methods, we examined a variety of clinical predictors and their association with response to both depression and CLBP ; change in depression; and change in pain scores at 6 weeks. Results About 26.4% of patients responded for both depression and pain with venlafaxine. Early improvement in pain at 2 weeks predicted improved response rates ( P  = 0.027). Similarly, positive changes in depression and pain at 2 weeks independently predicted continued improvement at 6 weeks in depression and pain, respectively ( P  < 0.001). Conclusions An important minority of patients benefitted from 6 weeks of venlafaxine 150 mg/day. Early improvement in depression and pain at 2 weeks may predict continued improvement at week 6. Future studies must examine whether patients who have a poor initial response may benefit from increasing the SNRI dose, switching, or augmenting with other treatments after 2 weeks of pharmacotherapy.