A controlled trial of methods for managing pain in primary care patients with or without co-occurring psychosocial problems

Abstract

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.

Figure 1.

Flow diagram of enrollment and randomization.

Figure 2.

Impact of INFOFEED+NE on patient-reported functional outcomes (patients with pain and psychosocial problems). Note: Open circles represent the difference in change scores between INFOFEED+NE and controls, and the lines represent the 95% confidence interval. INFOFEED+NE = patient information and physician feedback plus nurse-educator, SF-36 = Medical Outcomes Study 36-Item Short-Form; BP = bodily pain; RP = role physical; PF = physical function; VT = vitality; RE = role emotional; SF = social function; FIE = functional interference estimate.

Figure 2.

Impact of INFOFEED+NE on patient-reported functional outcomes (patients with pain and psychosocial problems). Note: Open circles represent the difference in change scores between INFOFEED+NE and controls, and the lines represent the 95% confidence interval. INFOFEED+NE = patient information and physician feedback plus nurse-educator, SF-36 = Medical Outcomes Study 36-Item Short-Form; BP = bodily pain; RP = role physical; PF = physical function; VT = vitality; RE = role emotional; SF = social function; FIE = functional interference estimate.