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A Controlled Trial of Methods for Managing Pain in Primary Care Patients With or Without Co-Occurring Psychosocial Problems

¹ Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH
² Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
³ Department of Orthopedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
⁴ Center for Evaluative Clinical Sciences, Dartmouth-Hitchcock Medical Center, Lebanon, NH
⁵ Institute for Clinical Evaluative Studies, Department of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario

CORRESPONDING AUTHOR: Tim A. Ahles, PhD, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Center Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, ahlest{at}MSKCC.org

PURPOSE 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.

Key Words: Pain • primary health care • problem solving

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