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Primary Care Physicians Treat Somatization

Journal of General Internal Medicine volume 24, pages 829–832 (2009)Cite this article

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.

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Acknowledgements

We gratefully acknowledge the generous financial support of the Department of Family Practice, Henry Ford Health System, Detroit, MI and the Dean’s Office of the College of Human Medicine, Michigan State University, East Lansing, MI. This material was presented at the annual meeting of the Academy of Psychosomatic Medicine, Amelia Island, FL on November 17, 2007.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Michigan State University, East Lansing, MI, USA

    Robert C. Smith MD, MS, Joseph C. Gardiner PhD & Zhehui Luo PhD

  2. Henry Ford Health System, Detroit, MI, USA

    Susan Schooley PhD & Lois Lamerato PhD

  3. Florida State University, Tallahassee, FL, USA

    Kathryn Rost PhD

  4. B312 Clinical Center, East Lansing, MI, 48824, USA

    Robert C. Smith MD, MS

Authors
  1. Robert C. Smith MD, MS
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  2. Joseph C. Gardiner PhD
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  3. Zhehui Luo PhD
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  4. Susan Schooley PhD
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  5. Lois Lamerato PhD
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  6. Kathryn Rost PhD
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Corresponding author

Correspondence to Robert C. Smith MD, MS.

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Smith, R.C., Gardiner, J.C., Luo, Z. et al. Primary Care Physicians Treat Somatization. J GEN INTERN MED 24, 829–832 (2009). https://doi.org/10.1007/s11606-009-0992-y

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  • DOI: https://doi.org/10.1007/s11606-009-0992-y

KEY WORDS

  • somatization
  • medically unexplained symptoms
  • primary care mental health
  • patient-centered
  • provider–patient relationship