Abstract

The intersecting problems of high-impact chronic pain and the opioid overdose crisis continue to be major public health concerns because of prevalence, costs, disparities, and societal burden, yet very few solutions to support comorbid chronic pain, opioid dependence, and opioid-related harms are available. To address chronic pain and ineffective and potentially unsafe opioid use, the 2016 Comprehensive Addiction and Recovery Act (CARA) mandated that each VHA facility designate pain management teams (PMTs): interdisciplinary teams of providers including, at a minimum, providers with expertise in pain medicine, addiction medicine, behavioral medicine, and rehabilitation medicine. While interdisciplinary team-based care -- including access to addiction medicine and multimodal pain care -- is recommended, there is limited evidence for specific PMT models. More work is needed to understand how to best build and maintain effective PMTs equipped to care for veterans with high-impact chronic pain – particularly those who also may be experiencing opioid-related harms. In 2012, our team developed a PMT similar to interdisciplinary PMTs evaluated in other trials, but with a specific focus on mitigation of opioid-related harms, including the prescription of buprenorphine, first-line therapy for opioid dependence. Our PMT uses a biopsychosocial approach to improve pain-related function and opioid safety; recently, we used implementation facilitation to disseminate our approach to three other VHA facilities. A promising enhancement we propose to test in the present study is the use of Whole Health Coaches (WHCs) following the Whole Health Model. This model promotes a whole-person patient-centered approach emphasizing multiple determinants of health including social and emotional health, with a broader goal of overall well-being. WHCs may be a valuable addition to PMTs in building relationships with patients to engage them in positive behavioral change. While WHCs are starting to be implemented in some PMTs, this will be the first study to evaluate the impact of WHC for veterans with chronic pain and opioid dependence. In this proposal, “Pain management teams using Whole Health to optimize function and safety in veterans: The TEAMWORK trial,” we aim to compare the effectiveness of treatment with a usual care PMT (PMT-UC) vs. PMT treatment enhanced with Whole Health coaching (PMT-WHC) in a pragmatic effectiveness- implementation hybrid type 2 trial. In the UG3 pre-implementation preparatory phase, we will use formative evaluation to refine implementation materials, support four VHA facilities to prepare to participate as study sites, and train WHCs. In the UH3 implementation phase, we will conduct a multisite pragmatic trial, randomizing 432 patients, to compare PMT-UC vs. PMT-WHC on the primary composite outcome of pain- related interference and opioid safety. We will also evaluate the impact of PMT-WHC on buprenorphine initiation and maintenance, evaluate implementation facilitation strategies for building and sustaining PMTs, and conduct a budget impact analysis.

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DRA: Health Systems Science

DRE: Treatment - Implementation, TRL - Applied/Translational

Keywords: None at this time.

MeSH Terms: None at this time.