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

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
The Cycle of Low Back Pain and

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

Chronic Pain Gets National Scientific

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 no cost 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
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.


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