Do dialogues about concepts of pain reduce immigrant patients' reported spread of pain? A comparison between two consultation methods in primary care.
OBJECTIVE
Do dialogues about concepts of pain reduce the reported spread of pain more than the usual consultations?


METHODS
A 4-week programme in primary care for immigrants on sick-leave, aged 16-45 years, containing daily exercises and randomised to either four interviews and dialogues about pain with a female doctor (group A) or the usual consultations with a male doctor (group B).


METHODS
Two doctors made the first and the last evaluations (before and after the programme) containing diagnostics of tender-structure locations and depression (yes-no), and ratings of severity of psychosocial stressors. Anxiety about pain was noted (yes-no). The patients pointed to their painful areas and these were noted on pain drawings (0-18 fields). Median values were calculated, and non-parametric statistics were used to test for significant differences between groups and before-and-after values, and the correlation between the number of pain drawing fields and clinical variables.


RESULTS
Forty-five persons participated in the whole programme, Group A (8 men, 15 women), group B (7 men, 15 women). Many of them needed an interpreter. Participants in group A had more tender-structure locations (two vs. one in group B). Nearly half had depression and two-thirds had serious psychosocial stressors. Almost all reported anxiety about pain at the start, but afterwards significantly fewer in group A (22 vs. 16, p < 0.05). In both groups, the number of pain drawing fields decreased significantly from, in median, eight to four (p < 0.001), particularly among the women (A: p < 0.05 vs. B: p < 0.01). Some very distressed participants reported more spread of pain than at the start. Reduced spread of pain was not significantly correlated to any clinical variable.


CONCLUSIONS
Particularly the women in both consultation groups demonstrated much less spread of pain after treatment, despite similar clinical findings and less anxiety about pain in group A. The initially wide spread of pain may thus have been a way of communicating with the doctors.
Department of Clinical Sciences, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden. monica.lofvander@klinvet.ki.se
Monica B
MB
Löfvander
Alf W
AW
Engström
Edgar
E
Iglesias
D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods* / Q000523:psychology*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010808:Physical Examination / Q000379:methods / Q000523:psychology; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D011584:Psychology / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D012737:Sex Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D016896:Treatment Outcome