Peggy Compton, PhD, RN, FAAN
Manik Chhabra, MD
|Chronic pain is a prevalent and costly health condition in the US, for which up to 10% of Americans use opioids daily. Rates of chronic pain and daily opioid use are higher among veterans compared with civilian populations. The risks associated with ongoing opioid prescription, including overdose, addiction and diversion, are increasingly evident. Simultaneously, opioids are ineffective in treating chronic pain compared with opioid-sparing approaches. In particular, increasing mobility improves pain and decreases opioid use among patients with chronic pain. Limiting new opioid prescriptions and reducing use for chronic pain are now the standard-of-care recommendations by the CDC and VAMC.
The Corporal Michael Cresenz VA Medical Center recently created a pain-focused patient-centered primary care program (P-PACT) to decrease opioid use and improve functional outcomes in high-risk veterans with chronic pain. This pilot study will evaluate if connected health technology and behavioral incentives applied in the P-PACT setting can appreciably increase participation in activities that promote mobility, and subsequently reduce pain severity and opioid use.
Specifically, 60 new P-PACT enrollees will be randomly assigned to either: (1) usual care; (2)technology-enhanced care (TEC) – including daily text message reminders, remotely administered assessments of pain severity and medication use; or (3) TEC plus a financial incentive. Activity participation and increased mobility are the primary outcome, and secondary outcomes include opioid use, physical function and pain at 12 weeks. Results of this study will inform providers if connected health and behavioral incentives are effective in the management of patients with chronic pain.