Targeting Chronic Pain in Primary Care Settings Using Behavioral Health Consultants

Project Summary

Does incorporating Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) interventions in primary care settings have an effective impact on the functioning of patients who are experiencing chronic, musculoskeletal pain?

Currently, there isn’t much evidence to identify the level of impact that these brief and targeted interventions during a primary care visit have on people with chronic pain. This trial seeks to identify evidence of meaningful outcomes of BCBT-CP, such as decreased opioid medication, fewer emergency room visits for pain care, and then finally a focus on greater satisfaction with treatment plans.

Co-Principal Investigators

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CAPT Jeffrey Goodie, PhD

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Don McGeary, PhD

Impact and Contribution to PMC3 and Society

The present study is the first large-scale trial of nonpharmacological pain management delivered by behavioral health practitioners integrated into primary care clinics. It also represents one of the largest trials of telehealth booster treatment ever conducted. Outcomes from this trial will inform MHS pain management policy and will contribute to primary care-specific mechanisms of nonpharmacological pain management for the PMC3.​

Details

Institutions:
Uniformed Services University, Bethesda, MD
University of Texas Health Science Center, San Antonio, TX

Institute Providing Oversight:  University of Texas Health Science Center at San Antonio


Program Officer:
  Henry Nothnagel

Project Scientist:  Jamie Scheib

ClinicalTrials.gov Identifier:  Pending

Trial Status:  Awaiting regulatory approval for UH3

Project Narrative

Our research team has developed a manualized, telehealth-based booster protocol aligned with BCBT-CP content. In consultation with our study biostatisticians and our patient, clinic, Command and DHA stakeholders, we have revised our UH3 Project Narrative as a mixed-methods, patient-randomized pragmatic trial addressing these aims:

Primary Aim 1: Assess the effect of monthly telehealth booster contacts on long-term Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) pain outcomes (i.e., Defense and Veterans Pain Rating Scale [DVPRS] and PEG-3 score 6 and 12 months after starting treatment) compared to BCBT-CP without a booster in a sample of 716 Military Health Systems (MHS) beneficiaries referred to a Behavioral Health Consultant (BHC) for pain management using BCBT-CP.

Hypothesis 1: Patients who are randomized to BCBT-CP with monthly telehealth booster contacts will retain a significantly higher proportion of BCBT-CP treatment benefit (defined as the change in DVPRS score from the first to last BCBT-CP module) at 3-, 6-, 12-, and 18-month assessments compared to patients randomized to BCBT-CP without booster telehealth contacts.

Primary Aim 2: Assess the effect of monthly telehealth booster contacts on the number of BCBT-CP modules completed by patients referred to the BHC for pain management in a sample of 716 MHS beneficiaries referred to a BHC for pain management using BCBT-CP.

Hypothesis 2: Patients randomized to BCBT-CP with monthly telehealth booster contacts will attend significantly more BCBT-CP appointments with the BHC compared to those without booster contacts.

Secondary Aims: Use patient focus groups to assess satisfaction with BCBT-CP with and without telehealth boosters; use Fitbit and self-report data to assess change in activity between BCBT-CP with and without boosters.