Effects of training on general practitioners' management of pain in osteoarthritis: a randomized multicenter study.

OBJECTIVE: To evaluate the effects of a short interactive training program for general practitioners (GP) on pain management in patients with osteoarthritis (OA). METHODS: A multicenter, parallel-group study. GP were randomized to receive training on relationships and communication, pain evaluation, prescription, and negotiation of a patient contract or to a control group receiving a presentation about obtaining consent in trials. Outcomes were patient assessments of pain and functional ability. We invited 1500 GP to take part in the study. Those who volunteered to receive the training recruited outpatients from May 2001 to April 2002. Patients participating in the evaluation of the effects of the general practitioners' training had lower limb OA and pain on motion [> or = 40 mm on a visual analog scale (VAS)] and had indications for treatment with acetaminophen. The primary endpoint: sum of patient pain relief based on the daily VAS self-evaluation during the 2 weeks of the trial. RESULTS: In total, 180 GP (84 trained, 96 nontrained) enrolled 842 patients (414 and 428, respectively). Mean baseline VAS pain was 63 +/- 14 mm. Patients in the trained-GP group had better overall pain relief (316 +/- 290 mm/day vs 265 +/- 243 mm; p < 0.0001), greater improvement in Lequesne and WOMAC scores (p < 0.0001), and better overall perception of treatment (p = 0.002). Acetaminophen use was slightly higher in the trained group; however, the difference in pain relief remained statistically significant (p = 0.0003) after adjustment for this difference. CONCLUSION: This is the first study to demonstrate a positive effect of physician training on patients with a painful condition.

[Data recording using a personal digital assistant. Experience of prospective survey on pain in 3196 patients]. / Recueil de données par assistant personnel digital. Expérience d'un Observatoire prospectif de la douleur portant sur 3196 patients.

OBJECTIVE: To assess the interest of a personal digital assistant (PDA) when used as data collector in a prospective survey on pain in general practice. METHODS: Prospective, multicentre and national survey concerning the identification of 4g/24h paracetamol prescription conditions as well as the characterization of the pain justifying it. Data were collected with a dedicated PDA including an electronic visual analogue scale (VAS). It also included a data controlling program of probability, consistency, date recording and time of data entry. RESULTS: 3.196 patients were enrolled by 830 general practitioners (GPs). For 1.066 of them enrolled by 277 GPs, the consistency analysis showed an a posteriori data entry. However, for assessment of pain intensity using the VAS, the physical presence of the patient is mandatory because self-evaluation is the rule. CONCLUSION: The use of an electronic questionnaire permits the collection of good quality data and the possibility of a posteriori control and hence the identification of breaches in clinical trial protocols.

Acetaminophen as symptomatic treatment of pain from osteoarthritis.

Osteoarthritis is a major public health burden. The incidence of osteoarthritis increases with advancing age. Symptomatic treatments aimed at alleviating the pain and thereby restoring joint function form the basis of the treatment. The chronic course requires long-term treatment with special attention to minimizing the side effects of drugs. Acetaminophen has a good risk/benefit ratio that has prompted international consensus panels to recommend its use as first-line therapy in dosages of up to 4 g/day. This review discusses safety and efficacy data from randomized double-blind trials of acetaminophen used to alleviate pain caused by osteoarthritis.