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Health Services Research & Development

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HSR&D In Progress

September 2021

In This Issue: Helping Veterans Cope with and Conquer Pain
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COOPERATE for Pain Equity

Feature Article

Takeaway: This study is expected to help minority Veterans, who have historically faced systemic barriers to healthcare, become more active in their overall healthcare, which is critical to improving their chronic pain care. It also is expected to increase patient activation and self-efficacy, improve psychological functioning, and decrease pain intensity and interference.

Racial disparities in pain treatment have been extensively documented, and minority patients, including Veterans, are more likely to be under-treated for pain. Minority Veterans have pain documented less frequently, undergo more urine drug tests, and are more likely to be referred for substance abuse evaluation than White Veterans. Compounding these pain care disparities, minority Veterans exhibit lower levels of patient activation than Whites, likely due at least in part to historical and ongoing racial injustices in healthcare. Patient activation—having knowledge, confidence, and skills to manage health—is associated with better health experiences, self-management, and outcomes. Lower patient activation leads to less effective communication in healthcare settings. Less effective communication is associated with lower quality care, poorer patient-provider relationships, and treatment non-adherence. Further, poor communication is exacerbated by the documented difficulties in patient-provider communication about chronic pain and its treatment, particularly where opioids are concerned.

This ongoing study (July 2018 – June 2022) titled Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE) focuses on empowering patients to be more active in their pain care. COOPERATE is evaluating the effectiveness of a six-session telephone-delivered coaching intervention focused on increasing patient activation and teaching effective communication strategies. Because numerous treatment options with a wide range of risks and benefits exist, and minorities tend to be offered fewer pain treatment options, patient activation and communication are critical for optimal pain care. Specifically, the primary aim of this study is to test the effects of COOPERATE on patient activation, communication self-efficacy, pain intensity and interference, and psychological functioning. In addition, investigators will examine mediating and moderating effects in COOPERATE – and assess the facilitators and barriers to implementing the intervention.


COOPERATE is a Hybrid Type 1 study designed to test effectiveness while examining implementation facilitators and barriers. COOPERATE is enrolling 250 Black Veterans with chronic musculoskeletal pain from primary care clinics. Veterans are randomized either to the COOPERATE intervention or to an attention control arm. Guided by the RE-AIM framework [see box], investigators interviewed a purposefully selected sub-sample of Veterans in the intervention group to better prepare for COOPERATE's implementation.


None to report at this time.

Anticipated Impact

This study is expected to empower Black Veterans by teaching them strategies to become more activated and communicate more effectively in healthcare settings. These skills are critical to improving their chronic pain care. Study findings also are expected to increase patient activation and communication self-efficacy, ultimately leading to better pain management and improved psychological functioning. This is particularly important to VA’s Opioid Safety Initiative, which is designed to improve safe pain treatment for Veterans, but also requires Veterans who are able to explore pain treatments, along with their providers, that are feasible for their individual lifestyles and consistent with their symptom priorities and treatment goals.

Principal Investigator

Marianne S. Matthias, PhD, MS, is part of HSR&D’s Center for Health Information and Communication (CHIC) in Indianapolis, IN.


None to report as this time.

View study abstract

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