Prevalência de depressão em pacientes com dor crônica e o impacto do transtorno de humor na reabilitação: avaliação pré e pós-intervenção do programa de autogerenciamento da dor crônica

Abstract

Introduction: Chronic pain is a multidimensional condition, characterized not only by persistent physiological alterations but also by its profound impact on the emotional, cognitive, and social dimensions of affected individuals. Previous studies have demonstrated a strong association between chronic pain and mental disorders, particularly depression, establishing a highly prevalent comorbidity that poses substantial challenges to healthcare systems. Within this context, it is crucial to examine the influence of depressive symptoms on clinical outcomes in patients with chronic pain, especially in the setting of multidisciplinary interventions provided by the Brazilian Unified Health System (SUS). Objective: To evaluate the improvement in pain intensity and interference with daily life in patients with chronic pain, with and without depression, treated at the Multidisciplinary Pain Center (CMD) of the State University of Rio de Janeiro (UERJ), who participated in a pain self-management program and multidisciplinary treatment. Methods: Data analysis was performed on patients followed at the CMD/UERJ between 2021 and 2024 at two time points: baseline and post-intervention. Eligible participants were adults diagnosed with chronic pain who completed the PAGDC and responded to the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression Scale (HADS) at both baseline and program completion. Primary outcomes included improvements in pain intensity, pain interference with daily activities, and depressive symptoms. Statistical analyses were conducted to assess associations between sociodemographic and clinical variables and the outcomes of interest. Results: The prevalence of clinical symptoms of depression at the beginning of the intervention was 42.1% among the participants. A significant association was observed between the reduction of depressive symptoms and improvement in pain interference with daily activities (OR = 2.233; 95% CI: 1.420–3.530). Furthermore, women demonstrated superior functional outcomes, whereas patients with obesity (BMI ≥ 30) exhibited a lower likelihood of improvement in pain intensity. Conclusion: The reduction of depressive symptoms achieved through multidisciplinary interventions may represent a critical therapeutic pathway for enhancing functional outcomes in patients with chronic pain. The integration of psychological care into pain management strategies is fundamental to optimizing treatment effectiveness and improving quality of life.