Improving Veteran Access to Integrated Management of Chronic Back Pain

Co-Principal Investigators:

Steven George, PT, PhD

Nicole Hastings, MD

Sponsoring Institution: Duke University School of Medicine

Institute Providing Oversight: National Center for Complementary and Integrative Health (NCCIH)

Program Officer: Dave Clark (NCCIH)

Project Scientist: Bill Elwood, National Institute of Health Office of Behavioral and Social Sciences Research (OBSSR)

ClinicalTrials.gov Identifier: Not Yet Available

Trial Status: Currently in planning.

Project Summary:

Low back pain (LBP) is widely reported among military Veterans, and care for this highly prevalent condition often involves pharmacological or surgical approaches that carry higher than desired risks; in addition, data indicate the rate of chronic LBP is increasing, and Veterans are more likely than non-Veterans to have severe LBP. Although non-pharmacological pain management can be effective and has lower risk, best practices for treatment delivery to Veterans is largely unknown. Critical unanswered questions include how to best sequence and deliver non-pharmacological care to optimize long-term clinical outcomes, limit exposure to unnecessary diagnostic testing (e.g. advanced imaging), and minimize utilization of higher risk treatments (e.g. opioids, injections, or surgery).

To address these unanswered questions, this Demonstration Project proposes a pragmatic comparative effectiveness trial to improve access to recommended non-pharmacologic therapies for LBP in the Department of Veterans Affairs (VA) health care system. The proposed trial will compare the effectiveness of two LBP care pathways designed to enhance access to non-pharmacological pain treatments according to the most recent LBP practice guidelines and a biopsychosocial approach to care; the first pathway is a sequenced, multi-modal integrated approach incorporating pain modulatory treatment, tailored behavioral treatment, and home based activity. The second pathway is care management via pain navigator that facilitates coordinated use of existing VA and non-VA pain management resources. This trial will be conducted at eligible VA clinics that partner with the study team during the planning phase.