Primary care physicians treat somatization

J Gen Intern Med. 2009 Jul;24(7):829-32. doi: 10.1007/s11606-009-0992-y. Epub 2009 Apr 30.

Abstract

Background: We hypothesized that somatizing patients managed by primary care physicians (PCP) would improve with a relationship-based intervention.

Methods: We randomized 30 adults with medically unexplained symptoms to treatment or usual care. Four PCPs were trained to intervene with cognitive-behavioral, pharmacological, and patient-centered management and deployed the intervention with seven scheduled visits over 12 months. Outcomes obtained at baseline and 12 months were: Mental component summary (MCS), the primary endpoint, and measures of physical and psychological symptoms and of satisfaction with the PCP.

Results: Patients averaged 52.5 years; 83.3% were female; 79.6% were black. Using a difference of differences approach, we found that the intervention produced a large effect size (ES) (0.82; CI: 0.08 to 1.57) for the MCS in the predicted direction, similar to the ES for physical (-0.80; CI: -1.55 to -0.04) and psychological (-1.06; CI: -1.83 to -0.28) improvement and for increased satisfaction with the PCP (0.94; CI: 0.15 to 1.74). Using ANCOVA in a sensitivity analysis, we found that the ES fell slightly (0.59), while other measures were unchanged.

Conclusions: Moderate-large effect sizes support the hypothesis that PCPs can effectively treat somatization. This points to the importance of performing a full RCT.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Analysis of Variance
  • Case Management
  • Confidence Intervals
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nurse Practitioners
  • Physicians, Family*
  • Primary Health Care*
  • Somatoform Disorders / diagnosis
  • Somatoform Disorders / drug therapy*
  • Somatoform Disorders / therapy
  • Stress, Psychological
  • Surveys and Questionnaires