Chronic pain is a ubiquitous problem and growing concern for the Military Health System (MHS). Chronic musculoskeletal (MSK) pain is the most common chronic pain condition in the MHS. Numerous recommendations have been made to improve care for chronic MSK pain in the MHS. First, the Office of the Army Surgeon General is promoting transition of the MHS to a holistic health system that seeks to maintain, restore and improve health through team-based care supporting self-management and recognizing the complex, biopsychosocial nature of chronic pain. Second, a stepped care approach to pain management is advocated to make less intense but effective, first-line care broadly available and basing subsequent care on response to first-line options. While the MHS has articulated its vision for holistic pain care delivered within a stepped care framework, there is a need for research addressing key questions of which interventions are most effective and how to operationalize the stepped care model.

The PROmoting Pain Self-Management (PROs) trial will evaluate two different interventions that provide holistic pain care; Empowered Relief and Move to Health. Empowered Relief is a single-session, group intervention. Move-to-Health is an individual health coaching intervention. We will compare these two interventions to each other as first-line pain management options. We will also compare each intervention to usual care. Finally, we will examine the effectiveness of a stepped care approach that sequences the two interventions with patients initially receiving Empowered Relief, then receiving Move-to-Health if initial response is not adequate. The results of this project will provide critical information and strategies to provide holistic pain management for persons receiving care in the MHS.