Primary care physicians treat somatization.
BACKGROUND
We hypothesized that somatizing patients managed by primary care physicians (PCP) would improve with a relationship-based intervention.


METHODS
We randomized 30 adults with medically unexplained symptoms to treatment or usual care. Four PCPs were trained to intervene with cognitive-behavioral, pharmacological, and patient-centered management and deployed the intervention with seven scheduled visits over 12 months. Outcomes obtained at baseline and 12 months were: Mental component summary (MCS), the primary endpoint, and measures of physical and psychological symptoms and of satisfaction with the PCP.


RESULTS
Patients averaged 52.5 years; 83.3% were female; 79.6% were black. Using a difference of differences approach, we found that the intervention produced a large effect size (ES) (0.82; CI: 0.08 to 1.57) for the MCS in the predicted direction, similar to the ES for physical (-0.80; CI: -1.55 to -0.04) and psychological (-1.06; CI: -1.83 to -0.28) improvement and for increased satisfaction with the PCP (0.94; CI: 0.15 to 1.74). Using ANCOVA in a sensitivity analysis, we found that the ES fell slightly (0.59), while other measures were unchanged.


CONCLUSIONS
Moderate-large effect sizes support the hypothesis that PCPs can effectively treat somatization. This points to the importance of performing a full RCT.
Smith
Robert C
RC
Michigan State University, East Lansing, MI, USA. Robert.smith@ht.msu.edu
Gardiner
Joseph C
JC
Luo
Zhehui
Z
Schooley
Susan
S
Lamerato
Lois
L
Rost
Kathryn
K
D000223:Adaptation, Psychological; D000704:Analysis of Variance; D019090:Case Management; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010821:Physicians, Family; D011320:Primary Health Care; D013001:Somatoform Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D013315:Stress, Psychological; D011795:Surveys and Questionnaires