UMass Chan Medical School Faculty Publications


Depression predicts chronic pain interference in racially diverse, income-disadvantaged patients

UMMS Affiliation

Department of Family Medicine and Community Health; Center for Integrated Primary Care

Publication Date


Document Type



Artificial Intelligence and Robotics | Epidemiology | Health Psychology | Integrative Medicine | Movement and Mind-Body Therapies | Pain Management | Psychiatry and Psychology | Race and Ethnicity


BACKGROUND: Chronic pain is one of the most common reasons adults seek medical care in the US, with prevalence estimates ranging from 11% to 40%. Mindfulness meditation has been associated with significant improvements in pain, depression, physical and mental health, sleep, and overall quality of life. Group medical visits are increasingly common and are effective at treating myriad illnesses, including chronic pain. Integrative Medical Group Visits (IMGV) combine mindfulness techniques, evidence based integrative medicine, and medical group visits and can be used as adjuncts to medications, particularly in diverse underserved populations with limited access to non-pharmacological therapies.

OBJECTIVE AND DESIGN: The objective of the present study was to use a blended analytical approach of machine learning and regression analyses to evaluate the potential relationship between depression and chronic pain in data from a randomized clinical trial of IMGV in diverse, income disadvantaged patients suffering from chronic pain and depression.

METHODS: The analytical approach used machine learning to assess the predictive relationship between depression and pain and identify and select key mediators, which were then assessed with regression analyses. It was hypothesized that depression would predict the pain outcomes of average pain, pain severity, and pain interference.

RESULTS: Our analyses identified and characterized a predictive relationship between depression and chronic pain interference. This prediction was mediated by high perceived stress, low pain self-efficacy, and poor sleep quality, potential targets for attenuating the adverse effects of depression on functional outcomes.

CONCLUSIONS: In the context of the associated clinical trial and similar interventions, these insights may inform future treatment optimization, targeting, and application efforts in racialized, income disadvantaged populations, demographics often neglected in studies of chronic pain.

TRIAL REGISTRATION: NCT from 02262377. American Academy of Pain Medicine.


Depression, Chronic Pain, Stress, Self-Efficacy, Sleep, Pain Interference, depressive disorders, income, pain, self efficacy, sleep, stress, chronic pain, sleep quality, racial/ethnic diversity

DOI of Published Version



Nephew BC, Incollingo Rodriguez AC, Melican V, Polcari JJ, Nippert KE, Rashkovskii M, Linnell LB, Hu R, Ruiz C, King JA, Gardiner P. Depression predicts chronic pain interference in racially diverse, income-disadvantaged patients. Pain Med. 2021 Dec 15:pnab342. doi: 10.1093/pm/pnab342. Epub ahead of print. PMID: 34908146. Link to article on publisher's site


This article is based on a previously available preprint in medRxiv,

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Pain medicine (Malden, Mass.)

PubMed ID