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Primary care patients with pain and psychosocial problems benefit from nurse telephone calls

Primary care patients who suffer from pain are often plagued by psychosocial problems, including emotional problems, substance abuse, and domestic violence. These patients can gain substantial and sustained reduced pain and improvement in psychosocial problems, as well as physical function, when a nurse educator talks to them by telephone about problem-solving strategies and basic pain management skills, concludes a new study. Operating from a central location, nurses were able to achieve positive outcomes with an average of three telephone calls to each patient. This approach could benefit many primary care patients, given that more than one-third of Americans aged 19 to 69 years report levels of pain similar to the study patients, and about 40 percent also report psychosocial problems, notes Tim A. Ahles, Ph.D., of Dartmouth-Hitchcock Medical Center.

Dr. Ahles and fellow researchers randomized patients from 14 rural primary care practices (47 physicians) to usual care or intervention groups. Overall, 644 patients reported pain and psychosocial problems and 693 patients reported pain problems without psychosocial problems. Patients in the intervention group received information tailored to their problems and concerns (INFO). Their physicians received feedback about their patients' problems and concerns (FEED) and a nurse-educator (NE) telephoned patients to teach problem-solving strategies and basic pain management skills.

At the 6-month assessment, more patients in the INFOFEED + NE group than in the usual care group achieved meaningful improvement in bodily pain (53 vs. 40 percent), physical role (41 vs. 26 percent), social functioning (55 vs. 37 percent), and vitality (46 vs. 28 percent). However, there was no advantage in emotional role (32 vs. 22 percent) or physical function (36 vs. 27 percent). At 12 months, clinically meaningful differences were sustained for several of these measures. However, patients who received INFOFEED alone without the nurse calls experienced minimal improvements over the usual care group, which were not sustained at the 12 month assessment. The study was supported in part by the Agency for Healthcare Research and Quality (HS10265).

See "A controlled trial of methods for managing pain in primary care patients with or without co-occurring psychosocial problems," by Dr. Ahles, John H. Wasson, M.D., Janette L. Seville, Ph.D., and others, in the July 2006 Annals of Family Medicine 4(4), pp. 341-350.

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