A controlled trial of methods for managing pain in primary care patients with or without co-occurring psychosocial problems.
OBJECTIVE
Pain, a common reason for visits to primary care physicians, is often not well managed. The objective of this study was to determine the effectiveness of pain management interventions suitable for primary care physicians.


METHODS
Patients from 14 rural primary care practices (47 physicians) who reported diverse pain problems with (n = 644) or without (n = 693) psychosocial problems were randomized to usual-care or intervention groups. All patients in the intervention group received information tailored to their problems and concerns (INFO). These patients' physicians received feedback about their patients' problems and concerns (FEED). A nurse-educator (NE) telephoned patients with pain and psychosocial problems to teach problem-solving strategies and basic pain management skills. Outcomes were assessed with the Medical Outcomes Study 36-Item Short-Form and the Functional Interference Estimate at baseline, 6 months, and 12 months.


RESULTS
Patients with pain and psychosocial problems randomized to INFOFEED+NE significantly improved on the bodily pain (P = .011), role physical (P = .025), vitality (P <.001), role emotional (P = .048), and the Functional Interference Estimate (P = .027) scales compared with usual-care patients at 6 months. These improvements were maintained at the 12-month assessment even though these patients had received, on average, only 3 telephone calls. Compared with usual-care patients, at 6 months patients who received INFOFEED alone experienced minimal improvements that were not sustained at the 12-month assessment.


CONCLUSIONS
For patients with pain and psychosocial problems, telephone-based assistance resulted in significant, sustained benefit in pain and psychosocial problems.
Ahles
Tim A
TA
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. ahlest@MSKCC.org
Wasson
John H
JH
Seville
Janette L
JL
Johnson
Deborah J
DJ
Cole
Bernard F
BF
Hanscom
Brett
B
Stukel
Therese A
TA
McKinstry
Elizabeth
E
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D059408:Pain Management; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000379:methods*; D011369:Professional-Patient Relations; D011584:Psychology; D012424:Rural Population