Many primary care physicians do not feel capable of supporting patient self-management and the delivery of problem-solving therapy or cogni -

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 signifi cantly 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 12month assessment. CONCLUSIONS For patients with pain and psychosocial problems, telephonebased assistance resulted in signifi cant, sustained benefi t in pain and psychosocial problems. Ann Fam Med 2006;4:341-350. DOI: 10.1370/afm.527. INTRODUCTION Pain is among the most common complaints in primary care. It accounts for considerable suffering for patients, increased health care costs, and lost productivity, and pain is generally associated with low self-rated health.1-4 Psychosocial and psychiatric problems frequently are concurrent with pain and complicate its management.5,6 Pain management is most effective when it engages the patient in selfmanagement.7,8 Cognitive-behavioral approaches to pain management have shown effi cacy in decreasing pain and functional disability.9 Problemsolving therapy is an effi cient, effective approach for aiding patients with symptoms of depression and psychosocial issues associated with pain and other medical problems.10-12 Many primary care physicians do not feel capable of supporting patient self-management and the delivery of problem-solving therapy or cogniTim A. Ahles, PhD1 John H. Wasson, MD2 Janette L. Seville, PhD1 Deborah J. Johnson, BA2 Bernard F. Cole, PhD2 Brett Hanscom, MS3 Therese A. Stukel, PhD4,5 Elizabeth McKinstry, MA, RN1 1Department of Psychiatry, DartmouthHitchcock Medical Center, Lebanon, NH 2Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 3Department of Orthopedics, DartmouthHitchcock Medical Center, Lebanon, NH 4Center for Evaluative Clinical Sciences, Dartmouth-Hitchcock Medical Center, Lebanon, NH 5Institute for Clinical Evaluative Studies, Department of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Confl icts of interest: none reported 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@MSKCC.org