Keywords: chronic non-cancer pain; gender-sensitive care; intervention study

Background:

Treatment of chronic non-cancer pain (CNCP) is influenced by psychiatric comorbidities, is often unsuccessful, and can lead to frustration or resignation among patients and doctors. Increasing evidence indicates that sex- and gender-related factors affect CNCP management, including pain experience, pharmacotherapy, and doctor–patient communication.

Research questions:

To evaluate the feasibility of a novel, complex sex- and gender-sensitive intervention for patients with CNCP receiving long-term opioid therapy (LTOT) in primary care.

Method:

We conducted a single-arm mixed-methods trial. The intervention comprised two consultations including medication review, goal-setting, biographical interviews, and an empowerment dialogue based on the “Positive Health” concept. Qualitative feedback and quantitative outcomes were assessed at baseline (T0), 2 months (T1), and 5 months (T2). The primary outcome was the Pain Disability Index (PDI).

Results:

Of the 38 included patients, 31 received at least one comprehensive GESCO consultation. Between T0 and T2, the PDI decreased by −3.38 points (p=0.078). Pain intensity (0–10) decreased from 5.7 to 5.1 in men and from 6.1 to 5.5 in women. Improvements in pain intensity were associated with PDI reductions (p=0.026). Opioid dosage was reduced in six patients and increased in three. GPs reported improved patient access (93.0%) and new therapeutic impulses (76.7%). Qualitative analyses showed that biographical interviews frequently revealed gender-related influencing factors, and that men particularly benefited from structured psychosocial counseling tools.

Conclusions:

The GESCO intervention appears feasible in terms of exploratory clinical effects and warrants further evaluation in larger studies. Although consideration of gender-specific aspects facilitated access to doctors and patients, it was not perceived as a dominant factor during implementation. Overall, the intervention enabled greater personal attention, relationship building and more in-depth conversations.

Points for discussion:

Which methodological and practical considerations are essential when designing a larger, controlled follow-up study?

How can identified gender-related differences be translated into targeted and effective interventions to improve medical care?