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Kurt Kroenke, MD

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General Internal Medicine

Professor of Medicine

Academic Office

Health Information and Translational Sciences, Room Suite 2000
410 W. 10th St.
Indianapolis IN 46202-3002 Map

Contact Information

Phone: (317) 274-9046
Fax: (317) 630-6611
Email:

Education and Training

Fellowship University of Iowa Hospitals
Residency Baylor College of Medicine
Medicine (M.D.) Washington University
Chemistry, General Valparaiso University

Board Certifications

Internal Medicine 1980

Professional Organizations

Masters of the American College of Physicians

Publications (67)¹

Telemedicine screening for eye disease.
Journal: JAMA
Authors: Kroenke K;
Publication Date: 2015 Apr 28
Pragmatic characteristics of patient-reported outcome measures are important for use in clinical practice.
Journal: Journal of clinical epidemiology
Authors: Kroenke K; Monahan PO; Kean J;
Publication Date: 2015 Apr 11

Abstract

Measures for assessing patient-reported outcomes (PROs) that may have initially been developed for research are increasingly being recommended for use in clinical practice as well. Although psychometric rigor is essential, this article focuses on pragmatic characteristics of PROs that may enhance uptake into clinical practice.
View details for PubMedID 25962972
The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions.
Journal: The journal of pain : official journal of the American Pain Society
Authors: Hirsh AT; Hollingshead NA; Ashburn-Nardo L; Kroenke K;
Publication Date: 2015 Mar 27

Abstract

Although racial disparities in pain care are widely reported, much remains to be known about the role of provider and contextual factors. We used computer-simulated patients to examine the influence of patient race, provider racial bias, and clinical ambiguity on pain decisions. One hundred twenty nine medical residents/fellows made assessment (pain intensity) and treatment (opioid and non-opioid analgesics) decisions for 12 virtual patients with acute pain. Race (Black/White) and clinical ambiguity (high/low) were manipulated across vignettes. Participants completed the Implicit Association Test and feeling thermometers, which assess implicit and explicit racial biases, respectively. Individual- and group-level analyses indicated that race and ambiguity had an interactive effect on providers' decisions, such that decisions varied as a function of ambiguity for White but not Black patients. Individual differences across providers were observed for the effect of race and ambiguity on decisions; however providers' implicit and explicit biases did not account for this variability. These data highlight the complexity of racial disparities and suggest that differences in care between White and Black patients are, in part, attributable to the nature (i.e., ambiguity) of the clinical scenario. The current study suggests that interventions to reduce disparities should differentially target patient, provider, and contextual factors.
View details for PubMedID 25828370
Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts: A Randomized Clinical Trial.
Journal: JAMA internal medicine
Authors: Bair MJ; Ang D; Wu J; Outcalt SD; Sargent C; Kempf C; Froman A; Schmid AA; Damush TM; Yu Z; Davis LW; Kroenke K;
Publication Date: 2015 Mar 9

Abstract

Despite the prevalence and the functional, psychological, and economic impact of chronic pain, few intervention studies of treatment of chronic pain in veterans have been performed.
View details for PubMedID 25751701
Lower PHQ-9 cutpoint accurately diagnosed depression in people with long-term conditions attending the Accident and Emergency Department.
Journal: Journal of affective disorders
Authors: Hyphantis T; Kotsis K; Kroenke K; Paika V; Constantopoulos S; Drosos AA; Carvalho AF; Guthrie E; On behalf of the ARISTEIA-ABREVIATE Study Group members;
Publication Date: 2015 Feb 7

Abstract

Major Depressive Disorder (MDD) is frequent in the Accident and Emergency Department (AED) but is often unrecognized. We aimed to assess the prevalence of MDD and determine the psychometric properties of the PHQ-9 in diagnosing MDD in patients with long-term medical conditions attending an AED.
View details for PubMedID 25721612
Long-term evaluation of opioid treatment in fibromyalgia.
Journal: The Clinical journal of pain
Authors: Peng X; Robinson RL; Mease P; Kroenke K; Williams DA; Chen Y; Faries D; Wohlreich M; McCarberg B; Hann D;
Publication Date: 2015 Jan

Abstract

In a 12-month observational study, we evaluated the effect of opioid use on the outcomes in 1700 adult patients with fibromyalgia.
View details for PubMedID 24480913
Distance therapy to improve symptoms and quality of life: complementing office-based care with telehealth.
Journal: Psychosomatic medicine
Authors: Kroenke K;
Publication Date: 2014 Oct

Abstract

Two randomized trials exemplify strategies for administering behavioral interventions through distance therapy-the use of telemedicine or e-health approaches to treating patients outside the conventional in-person office-based visit. In the first trial, telephone-based coping skills training for patients with chronic obstructive pulmonary disease was not more effective than an education control in reducing mortality or rehospitalization. However, it was superior in improving psychological and somatic quality of life. In the second trial, a web-based distress management program was not more effective than usual care in postoperative psychological outcomes in patients receiving an implantable cardioverter defibrillator. However, both of these trials raise important methodological issues in designing and interpreting trials testing telehealth delivery of behavioral interventions. Key issues include: 1) selection of the appropriate control group (e.g., when may a usual care or active comparator be preferable to an attention control?); 2) choice of the appropriate outcome (i.e., one most likely to respond to the specific intervention); 3) enrolling only patients who have at least some threshold level of the symptom or risk level for the outcome being targeted by the intervention; 4) focusing on patients likely to participate in telehealth or other distance-administered treatment programs; and 5) optimal timing for the delivery of behavioral interventions that may occur around the time of major events such as hospitalization or procedures. A policy implication is that once distance therapy interventions are proven effective, reimbursement changes will be necessary to enhance the likelihood of uptake by providers and health care systems.
View details for PubMedID 25304115
Preferences, experience, and attitudes in the management of chronic pain and depression: a comparison of physicians and medical students.
Journal: The Clinical journal of pain
Authors: Hirsh AT; Hollingshead NA; Bair MJ; Matthias MS; Kroenke K;
Publication Date: 2014 Sep

Abstract

The current study investigated clinicians' treatment preferences for chronic pain and depression and the extent to which these preferences were related to clinicians' experience and attitudes.
View details for PubMedID 24064934
Operating characteristics of PROMIS four-item depression and anxiety scales in primary care patients with chronic pain.
Journal: Pain medicine (Malden, Mass.)
Authors: Kroenke K; Yu Z; Wu J; Kean J; Monahan PO;
Publication Date: 2014 Aug 19

Abstract

Depression and anxiety are prevalent in patients with chronic pain and adversely affect pain, quality of life, and treatment response. The purpose of this psychometric study was to determine the reliability and validity of the four-item Patient Reported Outcomes Measurement Information System (PROMIS) depression and anxiety scales in patients with chronic pain.
View details for PubMedID 25138978
Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors.
Journal: Psycho-oncology
Authors: Johns SA; Brown LF; Beck-Coon K; Monahan PO; Tong Y; Kroenke K;
Publication Date: 2014 Aug 17

Abstract

Cancer-related fatigue (CRF) is one of the most common, persistent, and disabling symptoms associated with cancer and its treatment. Evidence-based treatments that are acceptable to patients are critically needed. This study examined the efficacy of mindfulness-based stress reduction (MBSR) for CRF and related symptoms.
View details for PubMedID 25132206
Validity of the Greek version of the PHQ 15-item Somatic Symptom Severity Scale in patients with chronic medical conditions and correlations with emergency department use and illness perceptions.
Journal: Comprehensive psychiatry
Authors: Hyphantis T; Kroenke K; Papatheodorou E; Paika V; Theocharopoulos N; Ninou A; Tomenson B; Carvalho AF; Guthrie E; ARISTEIA-ABREVIATE Study Group members;
Publication Date: 2014 Aug 15

Abstract

The PHQ-15 is a brief measure assessing the severity of somatic symptoms and is widely used in different health care settings. We aimed to assess the psychometric properties of its Greek version in patients with chronic physical illnesses seeking urgent or unscheduled care in the Accident and Emergency Department (AED).
View details for PubMedID 25217309
Cost effectiveness of telecare management for pain and depression in patients with cancer: results from a randomized trial.
Journal: General hospital psychiatry
Authors: Choi Yoo SJ; Nyman JA; Cheville AL; Kroenke K;
Publication Date: 2014 Jul 19

Abstract

Pain and depression are prevalent and treatable symptoms among patients with cancer, yet they are often undetected and undertreated. The Indiana Cancer Pain and Depression (INCPAD) trial demonstrated that telecare management can improve pain and depression outcomes. This article investigates the incremental cost effectiveness of the INCPAD intervention.
View details for PubMedID 25130518
Telecare collaborative management of chronic pain in primary care: a randomized clinical trial.
Journal: JAMA
Authors: Kroenke K; Krebs EE; Wu J; Yu Z; Chumbler NR; Bair MJ;
Publication Date: 2014 Jul 16

Abstract

Chronic musculoskeletal pain is among the most prevalent, costly, and disabling medical disorders. However, few clinical trials have examined interventions to improve chronic pain in primary care.
View details for PubMedID 25027139
Are the harms of false-positive screening test results minimal or meaningful?
Journal: JAMA internal medicine
Authors: Kroenke K;
Publication Date: 2014 Jun
The somatic symptom scale-8 (SSS-8): a brief measure of somatic symptom burden.
Journal: JAMA internal medicine
Authors: Gierk B; Kohlmann S; Kroenke K; Spangenberg L; Zenger M; Brähler E; Löwe B;
Publication Date: 2014 Mar

Abstract

Somatic symptoms are the core features of many medical diseases, and they are used to evaluate the severity and course of illness. The 8-item Somatic Symptom Scale (SSS-8) was recently developed as a brief, patient-reported outcome measure of somatic symptom burden, but its reliability, validity, and usefulness have not yet been tested.
View details for PubMedID 24276929
The influence of patient sex, provider sex, and sexist attitudes on pain treatment decisions.
Journal: The journal of pain : official journal of the American Pain Society
Authors: Hirsh AT; Hollingshead NA; Matthias MS; Bair MJ; Kroenke K;
Publication Date: 2014 Feb 24

Abstract

Research suggests that patient sex, provider sex, and providers' sexist attitudes interact to influence pain care; however, few empirical studies have examined these influences. We investigated sex (patient and provider) differences in pain treatment and the extent to which providers' sexist attitudes were associated with these differences. Ninety-eight health care providers (52% female) completed the Ambivalent Sexism Inventory and made treatment ratings for 16 computer-simulated patients with low back pain. Patient sex was balanced across vignettes. Results indicated that female patients received significantly higher antidepressant (F[1, 96] = 4.51, P < .05, ?p(2) = .05) and mental health referral (F[1, 96] = 3.89, P = .05, ?p(2) = .04) ratings than male patients, which is consistent with our hypotheses; however, these differences were significant only among female providers. Controlling for providers' sexism scores did not substantially alter these results, which is counter to our hypotheses. These results suggest that female providers are more likely to recommend psychosocial treatments for female than for male pain patients, and providers' sexist attitudes do not account for these differences. Research is needed to elucidate the contributors to sex/gender differences in treatment in order to reduce pain disparities.
View details for PubMedID 24576430
Methods for the design of vasomotor symptom trials: the menopausal strategies: finding lasting answers to symptoms and health network.
Journal: Menopause (New York, N.Y.)
Authors: Newton KM; Carpenter JS; Guthrie KA; Anderson GL; Caan B; Cohen LS; Ensrud KE; Freeman EW; Joffe H; Sternfeld B; Reed SD; Sherman S; Sammel MD; Kroenke K; Larson JC; Lacroix AZ;
Publication Date: 2014 Jan

Abstract

This report describes the Menopausal Strategies: Finding Lasting Answers to Symptoms and Health network and methodological issues addressed in designing and implementing vasomotor symptom trials.
View details for PubMedID 23760428
Symptom burden and comorbidities impact the consistency of responses on patient-reported functional outcomes.
Journal: Archives of physical medicine and rehabilitation
Authors: Cheville AL; Basford JR; Dos Santos K; Kroenke K;
Publication Date: 2013 Aug 27

Abstract

To assess the influence of symptom intensity, mood, and comorbidities on patient-clinician agreement and the consistency of responses to functional patient-reported outcomes (PROs).
View details for PubMedID 23988394
The influence of patient's sex, race and depression on clinician pain treatment decisions.
Journal: European journal of pain (London, England)
Authors: Hirsh AT; Hollingshead NA; Bair MJ; Matthias MS; Wu J; Kroenke K;
Publication Date: 2013 Jun 30

Abstract

Pain treatments often vary across patients' demographic and mental health characteristics. Most research on this topic has been observational, has focused on opioid therapy exclusively and has not examined individual differences in clinician decision making. The current study examined the influence of patient's sex, race and depression on clinicians' chronic pain treatment decisions.
View details for PubMedID 23813861
Longitudinal observation of treatment patterns and outcomes for patients with fibromyalgia: 12-month findings from the reflections study.
Journal: Pain medicine (Malden, Mass.)
Authors: Robinson RL; Kroenke K; Williams DA; Mease P; Chen Y; Faries D; Peng X; Hann D; Wohlreich M; McCarberg B;
Publication Date: 2013 Jun 11

Abstract

To describe 12-month treatment patterns and outcomes for patients starting a new medication for fibromyalgia in routine clinical practice.
View details for PubMedID 23758985
Diagnostic testing and the illusory reassurance of normal results: comment on "Reassurance after diagnostic testing with a low pretest probability of serious disease".
Journal: JAMA internal medicine
Authors: Kroenke K;
Publication Date: 2013 Mar 25
Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis in Pancreatic Cancer: A Prospective Pilot Study of Safety Using 10?mL versus 20?mL Alcohol.
Journal: Diagnostic and therapeutic endoscopy
Authors: Leblanc JK; Rawl S; Juan M; Johnson C; Kroenke K; McHenry L; Sherman S; McGreevy K; Al-Haddad M; Dewitt J;
Publication Date: 2013 Jan 8

Abstract

Background. The dose of alcohol used in EUS-CPN is not standardized. The objective was to compare the safety of 20?mL alcohol versus 10?mL alcohol during EUS-CPN for patients with pancreatic cancer-related pain. Methods. 20 patients were selected to receive 10?mL or 20?mL of alcohol during EUS-CPN. Followup was done at baseline, 24 hours, and weekly. Health-related quality of life (HRQoL) was assessed at baseline, week 2, week 4, and every 4 weeks thereafter until pain returned. Results. There were no major complications in both groups. Minor self-limited adverse effects were seen in 6 (30%) subjects and included lightheadedness in 1 (5%), transient diarrhea in 2 (10%), and transient nausea and vomiting in 3. Pain relief was similar in both groups: 80% in the 10?mL group and 100% in the 20?mL group (P = 0.21). The mean (±?SD) duration of pain relief in the 10?mL and 20?mL groups was 7.9 ± 10.8 and 8.4 ± 9.2 weeks, respectively. 30% of patients in each group had complete pain relief. Conclusions. EUS-CPN using 20?mL of alcohol is safe. Similar clinical outcomes were seen in both groups. Further investigations to confirm these findings are warranted.
View details for PubMedID 23365492
Longitudinal relationships between fatigue and depression in cancer patients with depression and/or pain.
Journal: Health psychology : official journal of the Division of Health Psychology, American Psychological Association
Authors: Brown LF; Rand KL; Bigatti SM; Stewart JC; Theobald DE; Wu J; Kroenke K;
Publication Date: 2012 Aug 27

Abstract

Fatigue is one of the most common and debilitating symptoms reported by cancer patients, yet relatively little is understood about its etiology. Recently, as researchers have begun to focus attention on cancer-related fatigue (CRF), depression has emerged as its strongest correlate. Few longitudinal studies, however, have examined directionality of the relationship between the two symptoms. Our aim was to evaluate the directionality of the association between depression and CRF.
View details for PubMedID 22924447
Longitudinal comparison of three depression measures in adult cancer patients.
Journal: Journal of pain and symptom management
Authors: Johns SA; Kroenke K; Krebs EE; Theobald DE; Wu J; Tu W;
Publication Date: 2012 Aug 22

Abstract

Although a number of depression measures have been used with cancer patients, longitudinal comparisons of several measures in the same patient population have been infrequently reported.
View details for PubMedID 22921152
Comparative responsiveness of pain measures in cancer patients.
Journal: The journal of pain : official journal of the American Pain Society
Authors: Kroenke K; Theobald D; Wu J; Tu W; Krebs EE;
Publication Date: 2012 Jul 15

Abstract

Brief measures to assess and monitor pain in cancer patients are available, but few head-to-head psychometric comparisons of different measures have been reported. Baseline and 3-month data were analyzed from 274 patients enrolled in the Indiana Cancer Pain and Depression (INCPAD) trial. Participants completed the Brief Pain Inventory (BPI), the PEG (a 3-item abbreviated version of the BPI), the short form (SF)-36 pain scale, and a pain global rating of change measure. The global rating was used as the criterion for standardized response mean and receiver operating characteristic curve analyses. To assess responsiveness to the trial intervention, we evaluated standardized effect size statistics stratified by trial arm. All measures were responsive to global improvement, discriminated between participants with and without improvement, and detected a significant intervention treatment effect. Short and longer measures were similarly responsive. Also, composite measures that combined pain severity and interference into a single score (BPI total, PEG, SF-36 pain) performed comparably to separate measures of each domain (BPI severity and BPI interference).
View details for PubMedID 22800982
Telephone-based cognitive-behavioural therapy and a structured exercise programme are effective for chronic widespread pain (fibromyalgia).
Journal: Evidence-based medicine
Authors: Kroenke K;
Publication Date: 2012 Jun 26
Enhancing the clinical utility of depression screening.
Journal: CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
Authors: Kroenke K;
Publication Date: 2012 Jan 9
Comparing fibromyalgia across different clinical settings: is it apples and oranges, or oranges and tangerines?
Journal: European journal of pain (London, England)
Authors: Kroenke K;
Publication Date: 2011 Aug 27
Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care.
Journal: The journal of pain : official journal of the American Pain Society
Authors: Kroenke K; Wu J; Bair MJ; Krebs EE; Damush TM; Tu W;
Publication Date: 2011 Jun 16

Abstract

Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and co-occur 30 to 50% of the time. However, their reciprocal relationship and potentially causative effects on one another have been inadequately studied. Longitudinal data analysis involving 500 primary care patients with persistent back, hip, or knee pain were enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. Half of the participants had comorbid depression and were randomized to a stepped care intervention (n = 123) or treatment as usual (n = 127). Another 250 nondepressed patients with similar pain were followed in a parallel cohort. Outcomes were assessed at baseline, 3, 6, and 12 months. Mixed effects model repeated measures (MMRM) multivariable analyses were conducted to determine if change in pain severity predicted subsequent depression severity, and vice versa. Change in pain was a strong predictor of subsequent depression severity (t-value = 6.63, P < .0001). Likewise, change in depression severity was an equally strong predictor of subsequent pain severity (t-value = 7.28, P < .0001). Results from the full cohort were similar in the clinical trial subgroup. In summary, pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months.
View details for PubMedID 21680251
Cancer-related pain and disability: a longitudinal study.
Journal: Journal of pain and symptom management
Authors: Wang HL; Kroenke K; Wu J; Tu W; Theobald D; Rawl SM;
Publication Date: 2011 May 13

Abstract

Although the cross-sectional association between cancer-related pain and disability is well established, their longitudinal relationship has been less studied.
View details for PubMedID 21570808
Comparison of SF-36 vitality scale and Fatigue Symptom Inventory in assessing cancer-related fatigue.
Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Authors: Brown LF; Kroenke K; Theobald DE; Wu J;
Publication Date: 2011 Apr 10

Abstract

Cancer-related fatigue (CRF) is an important symptom in clinical practice and research. The best way to measure it, however, remains unsettled. The SF-36 vitality scale, a general measure of energy/fatigue, is a frequently cited measure. With only four items, however, its ability to adequately represent multiple CRF facets has been questioned. The 13-item Fatigue Symptom Inventory (FSI) was developed to assess multidimensional aspects of CRF. Our objectives were to assess the convergent validity and to compare the sensitivity to change of the two scales.
View details for PubMedID 21479788
Telecare management of pain and depression in patients with cancer: patient satisfaction and predictors of use.
Journal: The Journal of ambulatory care management
Authors: Johns SA; Kroenke K; Theobald DE; Wu J; Tu W;
Publication Date: 2011 Apr

Abstract

Pain and depression are 2 of the most common and disabling cancer-related symptoms. In the Indiana Cancer Pain and Depression trial, 202 cancer patients with pain and/or depression were randomized to the intervention group and received centralized telecare management augmented by automated symptom monitoring (ASM). Over the 12-month trial, the average patient completed 2 ASM reports and 1 nurse call per month. Satisfaction with both ASM and care management was high regardless of patient characteristics or cancer type. Adherence was also generally good, although several predictors of fewer ASM reports and nurse calls were identified. Only a minority of ASM reports triggered a nurse call, suggesting the efficiency of coupling clinician-delivered telecare management with automated monitoring.
View details for PubMedID 21415611
Training and career development for comparative effectiveness research workforce development: CTSA Consortium Strategic Goal Committee on comparative effectiveness research workgroup on workforce development.
Journal: Clinical and translational science
Authors: Kroenke K; Kapoor W; Helfand M; Meltzer DO; McDonald MA; Selker H;
Publication Date: 2010 Oct

Abstract

As comparative effectiveness research (CER) increasingly becomes a national priority, there are increased needs for training and workforce development in this area. Particularly important CER competencies include clinical epidemiology, biomedical informatics, economic analyses, systematic reviews, clinical practice guideline development, use of large databases and electronic health records for research, practice-based research, implementation and dissemination, health services research, and decision analysis. Institutions funded by Clinical and Translational Science Awards (CTSAs) should be one of the central stakeholders in providing training and career development in CER. Survey results regarding the current CER capacity and needs of CTSAs are presented, and recommendations are provided. Volume 5: 258-262.
View details for PubMedID 20973924
Analgesic prescribing for patients who are discharged from an emergency department.
Journal: Pain medicine (Malden, Mass.)
Authors: Terrell KM; Hui SL; Castelluccio P; Kroenke K; McGrath RB; Miller DK;
Publication Date: 2010 Jul

Abstract

Among patients who arrive at an emergency department (ED) with pain, over half remain in moderate or severe pain at ED discharge. Our objectives were to identify ED physicians' prescribing patterns when discharging patients with common musculoskeletal conditions and to determine if disparities in opioid prescribing exist.
View details for PubMedID 20642733
The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain.
Journal: Psycho-oncology
Authors: Brown LF; Kroenke K; Theobald DE; Wu J; Tu W;
Publication Date: 2010 Jul

Abstract

Depression is known to be a major problem in cancer patients, and evidence is emerging about the importance of anxiety. Because the disorders are highly comorbid, we examined the relationship of anxiety and depression with health-related quality of life (HRQL) in cancer patients.
View details for PubMedID 19777535
The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review.
Journal: General hospital psychiatry
Authors: Kroenke K; Spitzer RL; Williams JB; Löwe B;
Publication Date: 2010 May 7

Abstract

Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable.
View details for PubMedID 20633738
Review: GPs accurately diagnose about 50% of patients with depression and accurately classify 81% of nondepressed patients.
Journal: Annals of internal medicine
Authors: Kroenke K;
Publication Date: 2010 Apr 20
Predictors of pain outcomes in patients with chronic musculoskeletal pain co-morbid with depression: results from a randomized controlled trial.
Journal: Pain medicine (Malden, Mass.)
Authors: Ang DC; Bair MJ; Damush TM; Wu J; Tu W; Kroenke K;
Publication Date: 2009 Dec 9

Abstract

The combination of chronic musculoskeletal pain and depression is associated with worse clinical outcomes than either condition alone. In this study, we report the predictors of pain intensity and activity interference in primary care patients with co-morbid pain and depression.
View details for PubMedID 20002592
Sex Differences in Pain and Pain-Related Disability among Primary Care Patients with Chronic Musculoskeletal Pain.
Journal: Pain medicine (Malden, Mass.)
Authors: Stubbs D; Krebs E; Bair M; Damush T; Wu J; Sutherland J; Kroenke K;
Publication Date: 2009 Dec 9

Abstract

Although previous research suggests women report more severe pain than men, evidence for sex-related differences in pain-related disability is conflicting. Also, the impact of psychological factors on sex differences in disability is uncertain.
View details for PubMedID 20002591
Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression.
Journal: Pain medicine (Malden, Mass.)
Authors: Bair MJ; Matthias MS; Nyland KA; Huffman MA; Stubbs DL; Kroenke K; Damush TM;
Publication Date: 2009 Oct

Abstract

To identify barriers and facilitators to self-management of chronic musculoskeletal pain among patients with comorbid pain and depression.
View details for PubMedID 19818038
Cancer-related fatigue and its associations with depression and anxiety: a systematic review.
Journal: Psychosomatics
Authors: Brown LF; Kroenke K;
Publication Date: 2009 Sep

Abstract

Fatigue is an important symptom in cancer and has been shown to be associated with psychological distress.
View details for PubMedID 19855028
Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial.
Journal: JAMA
Authors: Kroenke K; Bair MJ; Damush TM; Wu J; Hoke S; Sutherland J; Tu W;
Publication Date: 2009 May 27

Abstract

Pain and depression are the most common physical and psychological symptoms in primary care, respectively. Moreover, they co-occur 30% to 50% of the time and have adverse effects on quality of life, disability, and health care costs.
View details for PubMedID 19470987
The Indiana Cancer Pain and Depression (INCPAD) trial Design of a telecare management intervention for cancer-related symptoms and baseline characteristics of study participants.
Journal: General hospital psychiatry
Authors: Kroenke K; Theobald D; Norton K; Sanders R; Schlundt S; McCalley S; Harvey P; Iseminger K; Morrison G; Carpenter JS; Stubbs D; Jacks R; Carney-Doebbeling C; Wu J; Tu W;
Publication Date: 2009 Apr 5

Abstract

Pain and depression are two of the most prevalent and treatable cancer-related symptoms, each present in at least 20-30% of oncology patients. Both symptoms are frequently either unrecognized or undertreated, however. This article describes a telecare management intervention delivered by a nurse-psychiatrist team that is designed to improve recognition and treatment of pain and depression. The enrolled sample is also described.
View details for PubMedID 19410103
Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews.
Journal: General hospital psychiatry
Authors: Kroenke K; Krebs EE; Bair MJ;
Publication Date: 2009 Mar 4

Abstract

Chronic pain is one of the most prevalent, costly and disabling conditions in both clinical practice and the workplace, yet often remains inadequately treated. Moreover, chronic pain commonly co-occurs with depression, anxiety and somatoform disorders, and adversely affects response of these conditions to psychiatric treatments. This article provides an evidence-based approach to the pharmacotherapy of chronic pain.
View details for PubMedID 19410099
Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya.
Journal: Journal of general internal medicine
Authors: Monahan PO; Shacham E; Reece M; Kroenke K; Ong'or WO; Omollo O; Yebei VN; Ojwang C;
Publication Date: 2008 Nov 20

Abstract

Depression greatly burdens sub-Saharan Africa, especially populations living with HIV/AIDS, for whom few validated depression scales exist. Patient Health Questionnaire-9 (PHQ-9), a brief dual-purpose instrument yielding DSM-IV diagnoses and severity, and PHQ-2, an ultra-brief screening tool, offer advantages in resource-constrained settings.
View details for PubMedID 19031037
Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients.
Journal: Psychosomatic medicine
Authors: Bair MJ; Wu J; Damush TM; Sutherland JM; Kroenke K;
Publication Date: 2008 Sep 16

Abstract

To assess the relationship between depression and anxiety comorbidity on pain intensity, pain-related disability, and health-related quality of life (HRQL).
View details for PubMedID 18799425
The PHQ-8 as a measure of current depression in the general population.
Journal: Journal of affective disorders
Authors: Kroenke K; Strine TW; Spitzer RL; Williams JB; Berry JT; Mokdad AH;
Publication Date: 2008 Aug 27

Abstract

The eight-item Patient Health Questionnaire depression scale (PHQ-8) is established as a valid diagnostic and severity measure for depressive disorders in large clinical studies. Our objectives were to assess the PHQ-8 as a depression measure in a large, epidemiological population-based study, and to determine the comparability of depression as defined by the PHQ-8 diagnostic algorithm vs. a PHQ-8 cutpoint > or = 10.
View details for PubMedID 18752852
A transdisciplinary training program for behavioral oncology and cancer control scientists.
Journal: Nursing outlook
Authors: McDaniel AM; Champion VL; Kroenke K;
Publication Date: 2008 May

Abstract

Transdisciplinary health research training has been identified as a major initiative to achieve the vision for research teams of the future as articulated in the National Institutes of Health (NIH) Roadmap for Medical Research. To address the need for scientists who can integrate diverse scientific approaches and work in transdisciplinary teams to solve complex health problems, Indiana University (IU) has designed an innovative training program that will provide the didactic and research experiences to enable trainees to establish productive careers in behavioral oncology and cancer control research. Development of a successful transdisciplinary training program requires mentorship, research, and a specialized curriculum that encompass a broad range of disciplines. The program capitalizes on a unique set of existing and emerging training opportunities resulting from the collaborative activities of the IU Simon Cancer Center, the IU Schools of Nursing and Medicine, and multiple research institutes and academic centers located in Indiana and neighboring states.
View details for PubMedID 18501750
Efficient and effective care of depression in medical settings.
Journal: Managed care (Langhorne, Pa.)
Authors: Kroenke K;
Publication Date: 2008 Mar
Efficacy of treatment for somatoform disorders: a review of randomized controlled trials.
Journal: Psychosomatic medicine
Authors: Kroenke K;
Publication Date: 2007 Dec

Abstract

To review the evidence from randomized clinical trials (RCTs) that have focused on the treatment of patients with Diagnostic and Statistical Manual of Mental Disorders, 4(th) Edition (DSM-IV) somatoform disorders. Although somatoform disorders are among the most common mental disorders presenting in the general medical setting, the strength of evidence for specific treatments has not been well synthesized.
View details for PubMedID 18040099
Somatoform disorders and recent diagnostic controversies.
Journal: The Psychiatric clinics of North America
Authors: Kroenke K;
Publication Date: 2007 Dec

Abstract

Classification is not a trivial matter. In Burmese Days, George Orwell writes, "It is devilish to suffer from a pain that is all but nameless. Blessed are they who are stricken only with classifiable diseases! Blessed are the poor, the sick, the crossed in love, for at least other people know what is the matter with them and will listen to their belly-achings with sympathy." Patients who have somatoform disorders are particularly susceptible to this Orwellian lamentation. They are afflicted by symptoms that defy simple explanations. As detailed in this article, there is a spectrum of medical and psychiatric factors that can cause or contribute to somatic symptom burden. Research is continuing to reveal the central mechanisms that may provide a common pathway for physical and psychologic symptoms. The dualism that places some somatic symptom disorders on Axis I and others on Axis III gradually may fade in the coming decades as what the unifying causes are among common symptoms and the multicausal nature of many symptoms are discovered. Meanwhile, the classification systems should continue to operate on pragmatic principles where mechanistic explanations are lacking. This will allow grouping patients into categories that inform research, scientific and patient communication, prognostication, and clinical management. Coupling a heuristic classification system with evidence-based measures for assessing severity and monitoring treatment outcomes are important steps in the optimal care of symptomatic patients.
View details for PubMedID 17938036
Impact of pain on the outcomes of depression treatment: results from the RESPECT trial.
Journal: Pain
Authors: Kroenke K; Shen J; Oxman TE; Williams JW Jr; Dietrich AJ;
Publication Date: 2007 Nov 19

Abstract

Pain is prevalent in patients with depression. The purpose of this study was to determine the impact of pain on depression treatment outcomes.
View details for PubMedID 18022319
Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study: design and practical implications of an intervention for comorbid pain and depression.
Journal: General hospital psychiatry
Authors: Kroenke K; Bair M; Damush T; Hoke S; Nicholas G; Kempf C; Huffman M; Wu J; Sutherland J;
Publication Date: 2007 Nov

Abstract

Depression and pain are common comorbid conditions that have reciprocal adverse effects on disability and treatment outcomes. The objective of this article is to describe a study that tests the effectiveness of a stepped-care approach using a combined medication-behavioral intervention.
View details for PubMedID 18022044
Revising the classification of somatoform disorders: key questions and preliminary recommendations.
Journal: Psychosomatics
Authors: Kroenke K; Sharpe M; Sykes R;
Publication Date: 2007 Jul

Abstract

As the DSM-V process unfolds, Somatoform Disorders are a diagnostic category for which major revisions seem warranted. The Conceptual Issues in Somatoform and Similar Disorders (CISSD) project recently convened three workshops, involving 24 experts. The CISSD identified key questions related to stakeholders; terminology; appropriate axis (I versus III); medically unexplained criteria; status of functional somatic syndromes; and symptom counts, grouping, lifetime recall, and checklists. Preliminary recommendations include substantial revision of the category of Somatization Disorder, elimination of Undifferentiated Somatoform Disorder and Pain Disorder, terminology changes, and potential shifting of certain disorders to different DSM categories or axes.
View details for PubMedID 17600162
Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection.
Journal: Annals of internal medicine
Authors: Kroenke K; Spitzer RL; Williams JB; Monahan PO; Löwe B;
Publication Date: 2007 Mar 6

Abstract

Anxiety, although as common as depression, has received less attention and is often undetected and undertreated.
View details for PubMedID 17339617
Duloxetine in practice-based clinical settings: assessing effects on the emotional and physical symptoms of depression in an open-label, multicenter study.
Journal: Primary care companion to the Journal of clinical psychiatry
Authors: Wohlreich MM; Wiltse CG; Desaiah D; Ye W; Robinson RL; Kroenke K; Kornstein SG; Greist JH;
Publication Date: 2007

Abstract

In placebo-controlled clinical trials, duloxetine has been shown to be effective and well-tolerated in patients with major depressive disorder (MDD). However, patients in registration trials may not be representative of patients in clinical practice. This study sought to assess the effectiveness, safety, and tolerability of duloxetine in diverse populations of outpatients with MDD.
View details for PubMedID 17934551
An exploratory study of primary care physician decision making regarding total joint arthroplasty.
Journal: Journal of general internal medicine
Authors: Ang DC; Thomas K; Kroenke K;
Publication Date: 2007 Jan

Abstract

For patients to experience the benefits of total joint arthroplasty (TJA), primary care physicians (PCPs) ought to know when to refer a patient for TJA and/or optimize nonsurgical treatment options for osteoarthritis (OA).
View details for PubMedID 17351843
Physician-estimated disease severity in patients with chronic heart or lung disease: a cross-sectional analysis.
Journal: Health and quality of life outcomes
Authors: Kroenke K; Wyrwich KW; Tierney WM; Babu AN; Wolinsky FD;
Publication Date: 2006 Sep 13

Abstract

We evaluated how well physicians' global estimates of disease severity correspond to more specific physician-rated disease variables as well as patients' self-rated health and other patient variables.
View details for PubMedID 16970808
Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders.
Journal: The Medical clinics of North America
Authors: Kroenke K; Rosmalen JG;
Publication Date: 2006 Jul

Abstract

Half of all outpatient encounters are precipitated by physical complaints, of which one third to one half are medically unexplained symptoms, and 20% to 25% are chronic or recurrent. Many of the patients suffer from one or more discrete symptoms, whereas others have functional somatic syndromes. Individual symptoms and somatic syndromes are associated with impaired quality of life, increased health care use, and diminished patient and provider satisfaction. This article provides an overview of (1) unexplained symptoms and somatization; (2) limitations of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition in classifying somatoform disorders; (3) predictors of psychiatric comorbidity in patients who have physical symptoms; and (4) measurement and management of symptoms.
View details for PubMedID 16843765
Predictors of incident chronic widespread pain among veterans following the first Gulf War.
Journal: The Clinical journal of pain
Authors: Ang DC; Peloso PM; Woolson RF; Kroenke K; Doebbeling BN;
Publication Date: 2006 Jul

Abstract

We sought to determine the predictors of incident chronic widespread pain (CWP), specifically, the effect of preexisting symptoms, stress, and psychosocial factors in the subsequent development of CWP among veterans from the first Gulf War (GW).
View details for PubMedID 16788343
How valid are family proxy assessments of stroke patients' health-related quality of life?
Journal: Stroke; a journal of cerebral circulation
Authors: Williams LS; Bakas T; Brizendine E; Plue L; Tu W; Hendrie H; Kroenke K;
Publication Date: 2006 Jun 29

Abstract

Proxy respondents are often needed to report outcomes in stroke survivors, but they typically systematically rate impairments worse than patients themselves. The magnitude of this difference, the degree of agreement between patients and proxies, and the factors influencing agreement are not well known.
View details for PubMedID 16809575
Physical symptom disorder: a simpler diagnostic category for somatization-spectrum conditions.
Journal: Journal of psychosomatic research
Authors: Kroenke K;
Publication Date: 2006 Apr

Abstract

To propose a simpler, more empiric, and patient-centered category for classifying physical symptoms that are "etiologically neutral," that is, not reliant on the assumption that symptoms that is poorly explained from a medical standpoint must de facto be psychological in origin.
View details for PubMedID 16581354
Factors associated with drug adherence and blood pressure control in patients with hypertension.
Journal: Pharmacotherapy
Authors: Morris AB; Li J; Kroenke K; Bruner-England TE; Young JM; Murray MD;
Publication Date: 2006 Apr

Abstract

To determine characteristics associated with drug adherence and blood pressure control among patients with hypertension, and to assess agreement between self-reported and refill adherences.
View details for PubMedID 16553506
Venlafaxine extended release in the short-term treatment of depressed and anxious primary care patients with multisomatoform disorder.
Journal: The Journal of clinical psychiatry
Authors: Kroenke K; Messina N 3rd; Benattia I; Graepel J; Musgnung J;
Publication Date: 2006 Jan

Abstract

This pilot study explored the efficacy and tolerability of extended-release venlafaxine (venlafaxine ER) in anxious and/or depressed patients with multisomatoform disorder (MSD).
View details for PubMedID 16426091
Outcomes among family caregivers of aphasic versus nonaphasic stroke survivors.
Journal: Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses
Authors: Bakas T; Kroenke K; Plue LD; Perkins SM; Williams LS;
Publication Date: 2006 Jan

Abstract

Adverse consequences are known to occur in family members responsible for providing care to stroke survivors. However, the differential effect of aphasic versus nonaphasic stroke on caregivers has not been well studied. This study compares selected outcomes (e.g., perceived task difficulty, depressive symptoms, and other negative stroke-related outcomes) among caregivers of aphasic (n = 46) and nonaphasic (n = 113) stroke survivors. Results indicated that caregivers of aphasic survivors perceived greater difficulty with tasks and had more negative stroke-related outcomes than caregivers of nonaphasic survivors. Communication with the survivor was rated as most upsetting and difficult by caregivers in the aphasic group, followed by managing behaviors. Lack of time for family and friends was evident. Female caregivers and caregivers of survivors with self-care deficits also perceived greater difficulty with tasks and negative outcomes. Comprehensive assessment of the unique needs of caregivers of aphasic survivors is suggested for more individualized nursing interventions.
View details for PubMedID 16422043
Impact of pain severity and location on health-related quality of life.
Journal: Rheumatology international
Authors: Ang DC; Kroenke K; McHorney CA;
Publication Date: 2005 Aug 11

Abstract

Despite evidence that persistent pain affects well-being, little is known about the relationship of the location of pain to psychological and functional well-being. To determine whether patients with musculoskeletal disorders (MSD) are more likely to be depressed and functionally disabled compared to patients with pain at other sites, we conducted a secondary data analysis of the Medical Outcome Study--an observational study of adult outpatients with chronic medical conditions. Of the 3,360 patients who completed the baseline assessment, 1,237 (36.8%) had MSD and 2,123 (63.2%) had no MSD. Among patients in the MSD group, 84.5% reported > or = mild pain as compared to 70% in the no MSD. In multivariate analyses, MSD patients were more likely than non-MSD patients to be depressed (beta coefficient=-1.9, p=0.008) and functionally disabled (beta coefficient=-4.4, p<0.0001). However, the impact of MSD was eliminated after controlling for pain severity. Regardless of the location of pain, pain severity appears to be an important correlate of functional status, both mental and physical.
View details for PubMedID 16096793
Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis.
Journal: The Journal of rheumatology
Authors: Ang DC; Choi H; Kroenke K; Wolfe F;
Publication Date: 2005 Jun

Abstract

Whether comorbid depression increases mortality in patients with rheumatoid arthritis (RA) is unknown. Our objective was to determine whether the presence of depression predicted mortality in patients with RA.
View details for PubMedID 15940760