Primary Care Physicians Treat Somatization
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- Smith, R.C., Gardiner, J.C., Luo, Z. et al. J GEN INTERN MED (2009) 24: 829. doi:10.1007/s11606-009-0992-y
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We hypothesized that somatizing patients managed by primary care physicians (PCP) would improve with a relationship-based intervention.
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.
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.
Moderate-large effect sizes support the hypothesis that PCPs can effectively treat somatization. This points to the importance of performing a full RCT.