Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms

VA Office of Research and Development215 enrolled

Overview

To maximize implementation potential of pain self-management in the VA, alternative delivery methods are needed to provide Veterans with education and support needed to self-manage their pain, without requiring additional resources from healthcare teams. A novel and promising approach is a peer coaching model, in which Veterans with chronic pain who are successfully managing their pain offer information, support, and mentorship to other Veterans with pain.

The investigators' goal is to test the effectiveness of a peer coaching model among Veterans. The investigators are examining feasibility for implementation alongside effectiveness, to shorten the timeline to implementation. Aim 1 (primary aim): To compare 6-month (primary endpoint) and 9-month (sustained effects) effects of peer-supported chronic pain self-management versus controls on overall pain (intensity and function). Hypothesis 1: Veterans in the peer support arm will experience reduced overall pain compared to controls. Aim 2 (secondary aim): To compare 6- and 9-month effects of peer-supported chronic pain self-management versus controls on self-efficacy, social support, pain coping, patient activation, health-related quality of life, and health service utilization. Hypothesis 2: Veterans in the peer support arm will experience greater self-efficacy, social support, pain coping, patient activation, and health-related quality of life, and lower health service utilization, compared to controls. Aim 3 (pre-implementation aim): To explore facilitators and barriers to implementation of peer support for chronic pain, intervention costs, and fidelity to the model.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

215

Conditions

Chronic Pain

Interventions

Peer Coach AssignmentBEHAVIORAL

Veterans will be assigned a peer coach to meet with for 6 months to discuss pain self-management.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * have musculoskeletal pain in the low back, cervical spine, or extremities (hip, knee, or shoulder) for 3 months * have at least moderate pain severity, defined by pain 5 on a 0 (no pain) to 10 (worst pain imaginable) scale * indicate willingness to engage in phone or in-person contact on a regular basis with another Veteran Exclusion Criteria: * if the electronic medical record indicates a diagnosis of a psychotic disorder (e.g., International Classification of Diseases (ICD) ICD-9 codes 295-295.9 for schizophrenia) * current substance dependence (e.g., ICD-9 codes 304-304.9) * severe medical conditions precluding participation (e.g., New York Heart Association Class III or IV heart failure, ICD-9 codes 428-428.9 ) * if the eligibility screener given to prospective participants reveals active suicidal ideation severe hearing or speech impairment * pending surgery for a musculoskeletal condition (e.g., back surgery)

Locations (1)

Richard L. Roudebush VA Medical Center, Indianapolis, IN

Indianapolis, Indiana, United States

Outcomes

Primary Outcomes

Brief Pain Inventory (BPI) (Overall Pain Assessment)

The BPI was developed to assess the severity of pain and the impact of pain on daily functioning, and has been validated in primary care studies. (Range = 0-10, 0 = no pain, 10 = worst pain imaginable)

Time frame: 6 months

Brief Pain Inventory (BPI) (Overall Pain Assessment)

Time frame: 9 months

Secondary Outcomes

Pain Catastrophizing

Pain Catastrophizing Scale, a 13-item scale that assesses catastrophizing - a pain belief that has been found to be a strong predictor of poor treatment response. (Range: 0-52, higher numbers = higher catastrophizing)

Time frame: 6 months

Perceived Social Support

Measures perceptions of social support.(Range: 12-84, higher numbers = higher perceptions of social support)

Time frame: 6 months

Perceived Social Support

Measures perceptions of social support.(Range: 12-84, higher numbers = higher perceptions of social support)

Time frame: 9 months

Self Efficacy

Adapted from the Arthritis Self Efficacy Scale (Range 0-10, higher numbers = higher self efficacy)

Time frame: 6 months

Self Efficacy

Adapted from the Arthritis Self Efficacy Scale (Range 0-10, higher numbers = higher self efficacy)

Data from ClinicalTrials.gov

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