Options for Pain Management using Nonpharmacological Strategies (OPTIONS)

使用非药物策略的疼痛管理选项（选项）

• 批准号: 10534972
• 负责人: Marianne Matthias
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2026-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10534972
• 关键词: Address; Adherence; Affect; Area; Behavior; Belief; Chronic; Cognitive Therapy; Communities; Complement; Complementary Health; Control Groups; Decision Aid; Effectiveness; Ensure; Fostering; Future; Goals; Guidelines; Hybrids; Individual; Integrative Medicine; Intervention; Interview; Investments; Life; Life Style; Light; Maintenance; Methodology; Modality; Motivation; Opioid; Outcome; Pain; Pain interference; Pain management; Patient-Centered Care; Patients; Pharmaceutical Preparations; Policies; Provider; Qualitative Methods; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Recovery; Reporting; Research; Research Design; Risk; Sampling; Self Efficacy; Site; System; Testing; Time; Variant; Veterans; Waiting Lists; Work; addiction; arm; behavioral health; chronic musculoskeletal pain; chronic pain; chronic pain management; effectiveness testing; effectiveness/implementation trial; evidence base; future implementation; group intervention; health related quality of life; hybrid type 1 study; implementation barriers; implementation evaluation; implementation facilitation; implementation facilitators; improved; innovation; intervention effect; motivational enhancement therapy; multimodality; novel; opioid tapering; pain-related disability; patient engagement; patient oriented; patient-level barriers; prescription opioid; primary care provider; primary endpoint; primary outcome; psychologic; response; secondary outcome; success; system-level barriers; tool; uptake; whole health

Background: In response to opioid-related harms and evidence supporting nonpharmacological treatments (NPTs) for chronic pain, VHA has prioritized multimodal pain treatment approaches that include evidence- based NPTs. However, NPTs are persistently underutilized, and Veteran-level barriers remain largely unaddressed. OPTIONS (Options for Pain management using Nonpharmacological Strategies) is focused on overcoming Veteran-level barriers to NPT use and adherence with 1) a decision aid to help patients understand and compare NPT options and find NPTs that work best with their goals and lifestyle, and 2) a coach who uses motivational interviewing to foster self-efficacy, prepare Veterans to discuss NPTs with their providers, and build patients’ confidence to manage their pain with NPTs. Significance: OPTIONS is directly responsive to HSR&D’s Opioid Solicitation by focusing on behavioral health and engagement of Veterans in non-medication treatments. OPTIONS also supports the 2016 Comprehensive Addiction and Recovery Act and numerous VA directives focused on increasing availability of NPTs. Innovation/Impact: Despite mounting evidence on the effectiveness of NPTs, there is a distinct lack of research aimed at overcoming patient-level barriers to NPT use. This is a critical gap that impedes pain management and the goal of reducing reliance on opioids. OPTIONS is the first study to use a tailored, patient-centered approach to address patient-level barriers to uptake of and adherence to NPTs. As such, OPTIONS provides an important complement to VA’s system-wide efforts aimed at promoting NPTs and helps ensure that VA’s substantial investment in these initiatives leads to increased use of NPTs and improved Veteran outcomes. Our partnership with VA Pain Management and the Office of Patient-Centered Care and Cultural Transformation will facilitate implementation of OPTIONS by leveraging existing Whole Health coaches if it is a positive trial—further enhancing the impact of this proposal. Specific Aims: Aim 1: Test the OPTIONS intervention’s effects on pain interference (primary outcome) among Veterans with chronic pain. Aim 2: Test the OPTIONS intervention’s effects on NPT use and secondary outcomes (health-related quality of life, psychological functioning, patient activation). Aim 3: Identify facilitators and barriers to implementing the OPTIONS intervention. Methodology: This Hybrid Type 1 study will test effectiveness while examining implementation facilitators and barriers. 296 Veterans with chronic musculoskeletal pain will be randomized to the intervention (10 weeks of coaching using motivational interviewing and the OPTIONS decision aid on NPTs) or to a waitlist control arm. We will examine outcomes at baseline and 3, 6 and 9 months. In Aim 3, we will use qualitative methods to understand facilitators and barriers to future implementation via interviews with a subset of intervention Veterans and with PCPs whose patients received the OPTIONS intervention. Implementation/Next Steps: Pending positive results, our next step will be a multi-site hybrid type 2 effectiveness-implementation trial, in which we will evaluate for implementation while continuing to test for effectiveness. We will work with our operational partners to implement the OPTIONS intervention using existing Whole Health Coaches, thereby helping to ensure sustainability. In addition, findings from Aim 3, which examines barriers and facilitators to implementation, will help to guide these next steps.

背景：应对阿片类药物有关的危害和支持非药物治疗的证据 （NPT）对于慢性疼痛，VHA优先考虑了包括证据的多模式疼痛治疗方法 - 基于NPT。但是，NPT持续未充分利用，资深级别的障碍仍然很大 未解决。选项（使用非药物策略进行疼痛管理的选项）重点是 克服不应该存和遵守的资深级别的障碍和1）帮助患者的决策援助 了解和比较不元的选项，并找到最适合其目标和生活方式的NPT，以及2） 使用动机面试来培养自我有效的教练，准备退伍军人与他们的NPT讨论NPT 提供者，并建立患者对NPT疼痛的信心。 意义：选择可以直接响应HSR＆D的阿片类药物诱使行为健康 和退伍军人参与非药物治疗。选项还支持2016年综合 成瘾和恢复法和众多VA指令着重于增加NPT的可用性。 创新/影响：尽管有证据表明NPT的有效性，但显然缺乏研究 旨在克服NPT使用的患者级障碍。这是阻碍疼痛管理的关键差距 以及减少阿片类药物缓解的目标。选择是第一次使用量身定制的，以患者为中心的研究 解决对患者级别的障碍和遵守NPT的障碍的方法。因此，选项提供 VA旨在促进NPT的全系统努力的重要完成，并有助于确保VA的 对这些举措的大量投资导致NPT的使用增加并改善了退伍军人成果。 我们与VA疼痛管理的合作伙伴关系以及以患者为中心的护理和文化的办公室 转型将通过利用现有的整个健康教练（如果是）来促进期权的实施 积极的试验 - 增强了该提案的影响。 具体目的：目标1：测试选项干预对疼痛干扰（主要结果）的影响 慢性疼痛的退伍军人。 AIM 2：测试期权干预对NPT使用和次要结果的影响（与健康有关的质量的质量 生活，心理功能，患者激活）。 目标3：确定促进者和障碍以实施期权干预。 方法论：这项混合型1研究将在检查实施促进者和 障碍。 296名患有慢性肌肉骨骼疼痛的退伍军人将随机分配给干预措施（10周的 使用动机访谈和对NPT的选项决策援助的指导）或候补控制部门。 我们将在基线和3、6和9个月时检查结果。在AIM 3中，我们将使用定性方法来 通过采访，了解促进者和未来实施的障碍 退伍军人和患者接受选择干预的PCP。 实施/下一步：等待积极的结果，我们的下一步将是多站点混合类型2 有效实施试验，我们将在继续测试的同时评估实施 效力。我们将与我们的运营合作伙伴合作，使用 现有的整个健康教练，从而有助于确保可持续性。此外，AIM 3的发现， 检查障碍和促进者实施，将有助于指导这些下一步。