In this Issue: Improving Treatment of Pain among Veterans
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Pain self-management, which involves treatment adherence, behavioral change, and coping skills, is an effective, evidence-based treatment for chronic pain that has been advocated by both the Institute of Medicine and the 2009 VHA Pain Management Directive. However, implementation of a pain self-management model in the VA healthcare system is challenging because of limited time and resources in primary care, where most chronic pain is managed. As a result, pharmacological treatments, including opioid analgesics, are frequently the first line of treatment, and pain self-management is under-utilized.
Evaluation of a Peer Coach-Led Intervention for the Improvement of Pain Symptoms (ECLIPSE) is a randomized controlled trial designed to test the effectiveness of a peer coach-delivered pain self-management intervention versus controls receiving a two-hour class on pain and pain self-management. ECLIPSE has the following specific aims:
- Compare 6-month (primary end point) and 9-month (sustained effect) effects of peer-supported chronic pain self-management versus control on overall pain (intensity and function);
- Compare 6- and 9-month effects of peer-supported chronic pain management versus control on self-efficacy, social support, pain coping, patient activation, health-related quality of life, and health service utilization; and
- Explore facilitators and barriers to the implementation of peer support for chronic pain, intervention costs, and fidelity to the model.
ECLIPSE participants include 215 Veterans who have chronic MSD pain and received care in VA primary care clinics, as well as 40 Veteran peer coaches. The 215 Veterans will be randomly assigned to the peer-coaching arm (n=120) or the control arm (n=95). Peer coaches will be assigned three Veterans each. The peer-coaching intervention will last six months and coaches and Veterans will be encouraged to meet (in person or by phone) at least bi-weekly. Peer coaches will be provided with a detailed manual and will be trained and supervised by the study nurse, who has delivered pain self-management interventions to Veterans in several previous studies. Investigators will then conduct interviews with peer coaches, Veteran participants, and VA Patient-Aligned Care Team (PACT) staff to determine facilitators and barriers to implementing a peer coach-led self-management program in primary care in the VA.
Results are expected to show that peer-coaching is a novel and promising approach in which Veterans with chronic pain who are successfully managing their own pain can offer information, support, and mentorship to other Veterans with pain.
Principal Investigator: Marianne Matthias, PhD, is part of HSR&D's Center for Health Information and Communication (CHIC) in Indianapolis, IN.
See HSR&D Project Abstract