ADAPT: Addressing Depression and Pain Together

Inclusion Criteria

• •1. Age 60 or older
• •2. Scores 10 or higher on the Patient Health Questionnaire-9 (PHQ-9). This is consistent with at least moderate depression severity.
• •3. Endorses low back pain more days than not, of at least moderate severity, for at least the past 3 months.
• •4. If venlafaxine up to 150 mg/day has been tried for at least 6 weeks, subjects must have been \*completely\* unresponsive for both depression and low back pain (based on subject report).
• •5. During this episode of CLBP, must have tried without continued success any of the following: 1) prescription or over the counter analgesics, 2) physical therapy, 3) acupuncture, 4) injection therapy, 5) had back surgery, 6) multidisciplinary pain program, 7) psychological treatment for chronic pain such as cognitive behavioral therapy or biofeedback, or 8) any other physician-prescribed treatment for chronic low back pain.
• •1. Repeat PHQ-9 with score
• •2. Current depression (major depression, partial remission of major depression, minor depression, or dysthymia) diagnosed with the PRIMEMD
• •3. 20-item Numeric Rating Scale for low back pain
• •4. The Montreal Cognitive Assessment (MoCA). Eligibility requires score of at least 24
• •5. No history of alcohol/substance abuse or dependence for the past six months. If subjects took more analgesics than prescribed for CLBP but there was no other evidence of abuse, they will be included. Alcohol and substance abuse will be assessed with the MINI-International Neuropsychiatric Interview.