Panel-based pain management in primary care: A pilot study

Although pain is an extremely common symptom presenting to primary care phy sicians, it frequently is not optimally managed. The purpose of this feasib ility study was to develop and pilot-test an efficient, rapid assessment an d management approach for pain in busy community practices. The interventio n utilized the Dartmouth COOP clinical Improvement System (DCCIS) and a tel ephone-based, nurse-educator intervention. Patients from four primary care practices in rural New Hampshire and Vermont were screened by mail for the presence of persistent pain. Patients with mild to severe pain were randomi zed to either the usual care control group (n=383) or the intervention grou p (n=320). Patients who reported pain but no psychosocial problems received a summary of identified problems and targeted educational material via mai l (DCCIS). Patients who reported pain and psychosocial problems received th e DCCIS intervention and calls from a nurse-educator who provided pain self -management strategies and a problem-solving approach for psychosocial prob lems. Post-treatment evaluation revealed that patients in the intervention group scored significantly better on the Pain, Physical, Emotional, and Soc ial subscales of the SF-36 and on the total score of the Functional Interfe rence Scale, as compared to a usual care control group. Feasibility and acc eptability of the approach were demonstrated; however, the conclusions base d on analyses of the post-treatment outcomes were tempered by baseline imba lances across groups. J Pain Symptom Manage 2001;22:584-590. (C) U.S. Cance r Pain Relief Committee, 2001.