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Microsoft word - summer 2011 final copy.docx
Jordan F. Karp, MD Bruce Rollman, MD, MPH Debra Weiner, MD Jill A. Tarr, LCSW Principal Investigator Co-Investigator Co-Investigator Project Coordinator ADAPT: ADDRESSING DEPRESSION AND PAIN TOGETHER 2011 Summer
What is ADAPT?
Funded by the National Institute on Aging for the next 4 years, the ADAPT study will test whether combined treatment with
antidepressant medication plus behaviorally
What happens during the study?
activating, pain and depression-specific
psychotherapy (compared to medication alone),
Participants meet regularly with the study team
is required to improve pain, depression and
(clinicians and study psychiatrists). In phase 1,
patients have 6-weeks of open-treatment with
low-dose venlafaxine (up to 150 mg/day) and
Eligibility for ADAPT:
If they are still experiencing symptoms of low
back pain or depression they will move into
Phase 2. During the 14 weeks of Phase 2,
patients are randomized to either high-dose
management or venlafaxine 300 mg/day and
How can I make a referral?
Problem Solving Therapy for Depression and
Why Venlafaxine (EFFEXOR)?
(triggered by ‘back pain’ in the problem
We chose venlafaxine because at doses > 150
mg/day, norepinephrine reuptake is inhibited.
3. Calling 412-246-6006. Ask for Jill Tarr.
BOTH depression and low back pain.
We screen all referred patients over the
telephone to confirm they meet criteria for low
back pain and depression. We then ask all
Q. Does the study provide medication for my
eligible patients to meet with study staff and
A: Yes, Venalafaxine and other interventions are
ensure that all eligibility requirements are met.
Q. Who will my patient call with questions while
Evaluations and treatment are offered at the
A. The Late Life Depression Clinic at 412-246-6006.
Bellefield Tower in Oakland, at the patient’s
This number answers 365/24/7, with a physician
Primary Care Office, or if they live within 5
always on-call. Q. How do I learn about my patient’s progress A. The Project Coordinator will chart updates in Jordan F. Karp, MD Bruce Rollman, MD, MPH Debra Weiner, MD Jill A. Tarr, LCSW Principal Investigator Co-Investigator Co-Investigator Project Coordinator ADAPT: ADDRESSING DEPRESSION AND PAIN TOGETHER 2011 Summer The Cycle of Low Back Pain and Depression: Patient Stories:
Initially Fred* was hesitant to join our study; he is a self-described “medication hater.” Despite his reservations, Fred stuck with us and the medication through the entire 20 weeks of the study. In phase 2, the dose of Effexor was increased to 300 mg and he was randomized to receive PST-DP. Fred said that his therapist, Rachel, “made me think—why put up with pain if I can do something about it?” Fred optimized his analgesic use, started physical therapy, obtained a wheeled walker, is
communicating more effectively with his family
and PCP, is walking more often, and is better
able to make decisions positively affecting his
higher-dose venlafaxine results in superior
health. His back pain is virtually gone, and it
has had a positive impact on many aspects of
PST-DP focuses on:
At her first visit, Beatrice* was experiencing
depressed. Now she is near completing the
3) Learning behavioral interventions for
second phase of the study and speaks very
highly of the program. Beatrice received
supportive management in addition to the
increased dose of Effexor. “The study helped
me get my life back, I feel much better than
when I first started. I hope this program can
help others. I’m feeling good and grateful for
all you’ve done for me.” Her pain is now rated
at a fraction of when she entered the project.
While she was not randomized to receive PST-DP, the attention to adherence, management
of treatment-emergent side effects, and close
monitoring of improvement led to good outcomes.
* Indicates that names have been changed, but these are indeed recent “graduates” of ADAPT. Jordan F. Karp, MD Bruce Rollman, MD, MPH Debra Weiner, MD Jill A. Tarr, LCSW Principal Investigator Co-Investigator Co-Investigator Project Coordinator ADAPT: ADDRESSING DEPRESSION AND PAIN TOGETHER 2011 Summer
Chronic Pain Gets National Scientific Attention:
The staff of ADAPT applaud the recent
publication by the prestigious Institute of
Medicine (IOM) entitled "Relieving Pain in America: A Blueprint for Transforming
Prevention, Care, Education, and Research."
Quick Facts about ADAPT
The first two sentences of the report observe
that, "Chronic pain affects at least 116 million
American adults – more than the total affected
combined. Pain also costs the nation up to
The medication we use is Venlafaxine xr.
$635 billion each year in medical treatment and
lost produc¬tivity." Given that the population of
Our offices are located at Bellefield
Pittsburgh and Allegheny County is among the
oldest in the country (in 2009, 16.8% of the
residents were older than 65 compared to a US
average of 12.9%), and that many painful
conditions, especially arthritis, increase with
experiencing an epidemic of persistent pain.
This long overdue monograph from the IOM
finally brings national attention to two problems
Participants can continue to take any
that we see daily: 1) chronic pain whittles away
at patient's quality of life, robs them of
the study, but we ask they not start any
restorative sleep, strains relationships, leads to
overuse of analgesics, and is associated with
medication and
chronic pain. Hopefully the research and
treatment at nocost and can be
clinical initiatives at Pittsburgh-based hospitals
reimbursed up to $130 for participating.
(such as the ADAPT Project) will assure the
physicians, prevent the conversion of acute to
chronic pain, and treat patients using self-
management and aggressive pharmacologic and non-pharmacologic treatment approaches.
Jordan F. Karp, MD Bruce Rollman, MD, MPH Debra Weiner, MD Jill A. Tarr, LCSW Principal Investigator Co-Investigator Co-Investigator Project Coordinator ADAPT: ADDRESSING DEPRESSION AND PAIN TOGETHER 2011 Summer Study Design: Jill A. Tarr, LCSW, Project Coordinator Jill is a Project Coordinator with the ADAPT Research Study. After receiving her MSW from the University of Pittsburgh, she worked in various positions as a community social worker ranging from community mental health, adoption, and geriatrics. Her research experience started in 2004 at WPIC and has included the Pittsburgh Girls study and the Puberty Study. Sunita Chickering, MA Senior Clinician Sunita graduated from the University of Iowa with a B.S. in Psychology and an M.A. in Rehabilitation Counseling. In the past, Sunita has worked with individuals with a wide range of disabilities including mental health problems such as depression and anxiety, as well as substance abuse problems. Sunita believes passionately in helping others to remove obstacles in their lives and obtain the quality of life they desire. Rachel San Pedro, LSW Senior Clinician
Rachel is a clinician with the ADAPT Research
Meet the Staff of Adapt
University of Pittsburgh, she worked as an
Jordan Karp, MD Principal Investigator
inpatient psychiatric social worker. Her
Dr. Karp is board certified in psychiatry with
research experience started in 1999 at WPIC
added qualifications in geriatric psychiatry. He
is Medical Director of Geriatric Psychiatry at
personality disorder, eating disorders, post-
UPMC Pain Medicine at Centre Commons, the
partum depression, and childhood trauma.
University of Pittsburgh Medical Center’s
multidisciplinary pain clinic. Dr. Karp’s NIH-
Chloe Bolon, B.S.
funded research focuses on: 1) primary care-
Research Specialist
based treatments for older adults living with co-
Chloe graduated magna cum laude from the
morbid pain and depression, and 2) stepped
care treatments for older adults with difficult to
psychology and political science. She sees
treat depression. Dr. Karp has published
patients in phase 1 of the ADAPT study. She
extensively in these areas and speaks often
also works on Dr. Karp’s studies using
about the treatment of depression in medically
ill populations both locally and nationally.
COUNCIL REGULATION (EEC) NO. 1768/92 IN THE MATTER OF Application Nos. SPC/GB/96/030, SPC/GB/96/031, SPC/GB/96/032, SPC/GB/96/033, SPC/GB/96/034 and SPC/GB/96/035 in the name of Takeda Chemical Industries Limited DECISION The issues Takeda Chemical Industries Limited (“the applicant”) filed six requests for the grant of aSupplementary Protection Certificate (“certificate”) on
1. - DATOS BASICOS 1.1.- Aspectos generales Dominica, cuya denominación proviene del latín y otorgada por el navegante Cristóbal Colon ante su descubrimiento, el día domingo 3 de noviembre de 1493, es parte de las Islas de Barlovento, ubicada al norte del grupo sur de las Antillas Menores. Fue la última en ser colonizada por los europeos. Francia cedió esta isla a Gran Bretaña en 1763 como