1. Supported in part by Arkansas Blue Cross and Blue Shield
and the Office of the Arkansas Drug Director and in partnership with the Arkansas Academy of Family Physicians (AAFP), the Arkansas Medical Society (AMS), the Arkansas State Medical Board (ASMB), the Arkansas Department of Health (ADH) and its Division of Substance Misuse and Injury Prevention (Prescription Drug Monitoring Program—PDMP)
Continuing Education Credit: TEXT:
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2. AR-IMPACT Team Members
Michael Cucciare, PhD
Johnathan Goree, MD
Corey Hayes, PharmD
Teresa Hudson, PharmD, PhD
Shona Ray-Griffith, MD
Leah Tobey, PT, DPT
Graduate Student: Andrea Melgar-Castillo

3. Flow of the Case Conferences
General Information: 5 minutes
Topic Presentation: 20 minutes
Case Conference: 25 minutes
Feedback and Thoughts on Future Sessions: 5 minutes

4. AR-IMPACT website: arimpact.uams.edu
AR-IMPACT address:
Joining the Conference:
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5. Faculty Disclosure of Financial Relationships:
The planners of this RSS, Corey Hayes, Michael Cucciare, Johnathan Goree, Leah Tobey, Teresa Hudson, Marti Morrison and Cathy Buzbee have no financial relationships with commercial interests to disclose. A planner of this RSS, Shona Ray-Griffith, MD, has a financial relationship with a commercial interest to disclose: Neuronetics, Inc. – Contracted Research. The speaker of this RSS has no financial relationships with commercial interests to disclose. The accreditation compliance reviewers of this RSS, Karen Fleming and Courtney Bryant, have no financial relationships with commercial interests to disclose.

6. Continuing Education
Accreditation: In support of improving patient care, University of Arkansas for Medical Sciences is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Credit Designation: The University of Arkansas for Medical Sciences designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The University of Arkansas for Medical Sciences designates this live activity for a maximum of 1 ANCC contact hour. Nurses must attend the entire session in order to receive credit.
This knowledge-based activity will provide pharmacists up to 1.0 contact hours or 0.1 CEU. ACPE# JA L01-P
AAFP Credit: Submit your AMA credit
Pharmacists: Please us your NABP number and month and day of birth

7. Other General Information
CISCO IPhone App
CISCO Meeting Information
Please mute your microphone in CISCO
Able to ask questions through CISCO Chat

8. Screening for Depression and Anxiety in Patients with Pain
Michael A. Cucciare, PhD
Psychologist, Women’s Mental Health Program
University of Arkansas for Medical Sciences
Text MICHAELCUCCI335 to join

9. Today’s Goals The reciprocal nature of depression, anxiety, and pain
Screening tools for depression and anxiety in patients with pain
Briefly describe care options for patients with depression and anxiety

10. What is depression and anxiety?
Depression – pervasive low mood; loss of interest in usual activities; diminished ability to experience pleasure
Anxiety – a physiological state characterized by cognitive, somatic, emotional, and behavioral components that contribute to fear and worry

11. Why talk about depression and anxiety in the context of pain?
Costs of depression/anxiety in pain:
Work and physical activities decrease
Utilization of medical services increases
Motivation and adherence are reduced
Poorer quality of life
And for the pain provider, make treating pain more challenging

12. How is depression related to pain?
Depression can contribute to pain
Patients with preexisting depression are more likely to develop pain (e.g., headache and chest pain)
Research shows that depression can be a consequence of protracted pain
Stress-diathesis model

13. How is anxiety related to pain?
Is the second most common mental health condition
(prevalence is twice that of the general population)
Is associated with:
Catastrophizing – dwelling on worst possible outcomes (associated with higher pain severity and disability in pain patients)
Hypervigilance – increased attendance to pain/inability to distract
Fear avoidance – avoidance of movement/activities out of fear of pain (counterproductive for physical rehabilitation)

15. Screening tools for depression
Many screeners exist, but first a caveat:
Some criteria for depression (fatigue, sleep problems, weight changes) can also be symptoms of pain leading to overestimating depression
Patient Health Questionnaire (PHQ – 9)
Patient Health Questionnaire (PHQ – 8)
Depression Anxiety Stress Scale (DASS- 21)

18. Screening tools for anxiety
Pain Anxiety Symptoms Scale Short Form 20
Generalized Anxiety Disorder -7

19. (PASS- 20 scores of greater than 30) Abrams, M. P. , Carleton, N
(PASS- 20 scores of greater than 30) Abrams, M. P., Carleton, N., and Asmundson, G.J.G. (2007). An exploration of the psychometric properties of the PASS-20 with a nonclinical sample. The Journal of Pain, 8 (11),
GAD-7 total score for the seven items ranges from 0 to 21. Scores of 5, 10, and 15 represent cut points for mild, moderate, and severe anxiety, respectively. ... Using the threshold score of 10, the GAD-7 has a sensitivity of 89% and a specificity of 82% for generalized anxiety disorder

20. Treatment options Behavioral
Cognitive Behavioral Therapy can help with depression and/or anxiety related to pain. It teaches patients:
Psychoeducation
Relaxation Training
Distraction techniques
Cognitive Restructuring
Behavioral Activation
Medication (SSRIs, SNRIs)
Increasing exercise or activity

22. What to take away
A reciprocal relationship exists between depression, anxiety, and pain
Patients with pain and depression and/or anxiety have worse pain and functional outcomes than those without these conditions
Brief screeners exist for use in busy primary care settings

23. Thank you!
Questions/comments?

24. Questions about the Topic
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25. Case Conference and Feedback
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