Options for Pain Management using Nonpharmacological Strategies (OPTIONS)

背景：对阿片类药物相关危害的反应和支持非药物治疗的证据

Background: In response to opioid-related harms and evidence supporting nonpharmacological treatments (NPTs) for chronic pain, VHA has prioritized multimodal pain treatment approaches that include evidence- based NPTs. However, NPTs are persistently underutilized, and Veteran-level barriers remain largely unaddressed. OPTIONS (Options for Pain management using Nonpharmacological Strategies) is focused on overcoming Veteran-level barriers to NPT use and adherence with 1) a decision aid to help patients understand and compare NPT options and find NPTs that work best with their goals and lifestyle, and 2) a coach who uses motivational interviewing to foster self-efficacy, prepare Veterans to discuss NPTs with their providers, and build patients’ confidence to manage their pain with NPTs. Significance: OPTIONS is directly responsive to HSR&D’s Opioid Solicitation by focusing on behavioral health and engagement of Veterans in non-medication treatments. OPTIONS also supports the 2016 Comprehensive Addiction and Recovery Act and numerous VA directives focused on increasing availability of NPTs. Innovation/Impact: Despite mounting evidence on the effectiveness of NPTs, there is a distinct lack of research aimed at overcoming patient-level barriers to NPT use. This is a critical gap that impedes pain management and the goal of reducing reliance on opioids. OPTIONS is the first study to use a tailored, patient-centered approach to address patient-level barriers to uptake of and adherence to NPTs. As such, OPTIONS provides an important complement to VA’s system-wide efforts aimed at promoting NPTs and helps ensure that VA’s substantial investment in these initiatives leads to increased use of NPTs and improved Veteran outcomes. Our partnership with VA Pain Management and the Office of Patient-Centered Care and Cultural Transformation will facilitate implementation of OPTIONS by leveraging existing Whole Health coaches if it is a positive trial—further enhancing the impact of this proposal. Specific Aims: Aim 1: Test the OPTIONS intervention’s effects on pain interference (primary outcome) among Veterans with chronic pain. Aim 2: Test the OPTIONS intervention’s effects on NPT use and secondary outcomes (health-related quality of life, psychological functioning, patient activation). Aim 3: Identify facilitators and barriers to implementing the OPTIONS intervention. Methodology: This Hybrid Type 1 study will test effectiveness while examining implementation facilitators and barriers. 296 Veterans with chronic musculoskeletal pain will be randomized to the intervention (10 weeks of coaching using motivational interviewing and the OPTIONS decision aid on NPTs) or to a waitlist control arm. We will examine outcomes at baseline and 3, 6 and 9 months. In Aim 3, we will use qualitative methods to understand facilitators and barriers to future implementation via interviews with a subset of intervention Veterans and with PCPs whose patients received the OPTIONS intervention. Implementation/Next Steps: Pending positive results, our next step will be a multi-site hybrid type 2 effectiveness-implementation trial, in which we will evaluate for implementation while continuing to test for effectiveness. We will work with our operational partners to implement the OPTIONS intervention using existing Whole Health Coaches, thereby helping to ensure sustainability. In addition, findings from Aim 3, which examines barriers and facilitators to implementation, will help to guide these next steps.