Improving Veteran Access to Integrated Management of Low Back Pain (AIM Back)

Project Summary

There are critical unanswered questions surrounding best practices for addressing chronic back pain in the veteran population.  This project is looking at increasing and improving veteran access to nonpharmacological approaches by developing and then comparing two different care pathways for people with low back pain.  Both the integrated care pathway and the coordinated care pathway will be evaluated for their effectiveness in limiting pain interference, minimizing sleep disturbances from pain, and improving quality of sleep.

Co-Principal Investigators

StevenGeorge150x225

Steven George, PT, PhD

Hastings

Susan Nicole Hastings, MD

Impact and Contribution to PMC3 and Society

The rate of reported low back pain is increasing, particularly so in the veteran population, where severe low back pain is more likely, as is the use, reliance on, and abuse of opioids.  This trial seeks to improve access to recommended nonpharmacological therapies, minimize utilization of higher-risk treatments such as opioids and surgery, and optimize long-term outcomes for reduced pain.

Details

Institutions:
 Duke University School of Medicine, Durham VA Medical Center

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

Program Officer:  Dave Clark, NCCIH

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

ClinicalTrials.gov Identifier:  NCT04411420

Trial Status:  Currently recruiting sites to participate in the trial

Project Narrative

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 PCT 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.

Steven George, PT, PhD, on Improving Patient Access to Integrated Pain Management of Chronic Back Pain, a pragmatic clinical trial on which he and colleague Susan Nicole Hastings, MD, are co-PIs.