Many patients experiencing chronic pain are also battling depression. Now researchers say they have developed an approach that helps to control both conditions at the same time.

Researchers report in JAMA, the Journal of the American Medical Association, a strategy involving they developed that includes individually tailored antidepressant medication coupled with pain self-management.

For the study, researchers from the Indiana University School of Medicine and the Regenstrief Institute focused on 250 people who had low back, hip, or knee pain for three months or longer along with moderate or worse depression.

About half the group was given usual care from their doctors for both depression and pain. The other group received careful monitoring of prescribed antidepressant medications for 12 weeks, along with 12 weeks of pain self-management training.

This training included muscle relaxation and deep breathing exercises as well as instruction in coping and distraction techniques. During each session with a nurse care manager, the patient was taught new strategies for pain management of had their techniques adjusted.

Depression was assessed with the Hopkins Symptom Checklist, and pain was assessed primarily with the Brief Pain Inventory.

Those whose depression medications were closely monitored and who were trained in pain self-management were two to three times more likely to report reduced depression than those in the control group.

They were also nearly four times as likely to experience complete remission (17.9 per cent vs. 4.7 per cent) 12 months later.

The patients were also much more likely than usual care patients to report improvement in their pain 12 months later (47.2 per cent vs. 12.6 per cent).

Overall, 26 per cent of the group who got the customized depression and pain management experienced a "composite response," meaning they reduced their depression by 50 per cent or more, and their pain by 30 per cent or more. That compares to just 7.9 per cent of the group who received the usual care.

The researchers say they were pleased with their findings but believe they can lessen pain and depression even more.

"In our next studies we plan to investigate cognitive behavioural therapy as well as optimizing pain medications to see if even greater improvements in pain can be achieved," reported Dr. Kurt Kroenke, an internist who is a former president of the Society of General Internal Medicine.

Kroenke notes that treating depression is a bit like treating high blood pressure, in that there are many medications available but it takes a while to figure out which ones work best for which patients.

The study authors say they're not sure why treating pain and depression together works. They say it may be that as pain improves, patients feel less depressed, or perhaps as depression lifts, patients experience pain as being less intense.

Or it may be that "both depression and pain lessened as a result of treatment effects on a common pathway," the authors write.

The researchers say that finding strategies that help relieve pain and depression are important because each can affect the treatment responsiveness of the other. What's more, both are among the leading causes of decreased work productivity, as well as some of the most common reasons for visits to family physicians.