Options for Pain Management using Nonpharmacological Strategies (OPTIONS)

背景：针对阿片类药物相关危害和支持非药物治疗的证据 对于慢性疼痛，VHA优先考虑多模式疼痛治疗方法，包括证据- 基于NPT。然而，NPT一直未得到充分利用，退伍军人级别的障碍仍然很大程度上 没有地址OPTIONS（使用非药物策略进行疼痛管理的选项）的重点是 克服退伍军人使用NPT的障碍，并坚持1）帮助患者的决策辅助 了解和比较NPT的各种选择，并找到最符合其目标和生活方式的NPT，以及2）a 教练谁使用动机面试，以培养自我效能，准备退伍军人讨论NPT与他们的 提供者，并建立患者的信心，以管理他们的疼痛与NPT。 意义：OPTIONS通过关注行为健康直接响应HSR&D的阿片类药物征集 以及退伍军人参与非药物治疗。OPTIONS还支持2016年全面 《成瘾和康复法》和许多退伍军人管理局的指令都集中在增加NPT的可用性上。 创新/影响：尽管越来越多的证据表明NPT的有效性，但明显缺乏研究 旨在克服患者使用NPT的障碍。这是阻碍疼痛管理的关键差距 以及减少对阿片类药物依赖的目标。OPTIONS是第一个使用量身定制的以患者为中心的 解决患者接受和遵守NPT的障碍的方法。因此，OPTIONS提供 这是对退伍军人事务部全系统努力促进NPT的重要补充，有助于确保退伍军人事务部的 对这些举措的大量投资导致了NPT的使用增加，并改善了退伍军人的结果。 我们与VA疼痛管理和以患者为中心的护理和文化办公室的合作伙伴关系 转型将通过利用现有的整体健康教练来促进OPTIONS的实施，如果它是一个 积极的尝试-进一步加强这一建议的影响。 具体目标：目标1：测试OPTIONS干预对疼痛干预（主要结局）的影响 患有慢性疼痛的退伍军人。 目标2：测试OPTIONS干预对NPT使用和次要结果（与健康相关的质量）的影响。 生活、心理功能、患者激活）。 目标3：确定实施OPTIONS干预措施的促进者和障碍。 方法：这一混合1型研究将测试有效性，同时检查实施促进者， 隔栏. 296名患有慢性肌肉骨骼疼痛的退伍军人将被随机分配到干预组（10周， 使用激励性面试和NPTs上的OPTIONS决策辅助进行辅导）或等待列表控制臂。 我们将在基线和3，6和9个月检查结果。在目标3中，我们将使用定性方法， 通过与干预措施子集的访谈，了解促进者和未来实施的障碍 退伍军人和患者接受OPTIONS干预的PCP。 实施/下一步：在取得积极成果之前，我们的下一步将是多站点混合型2 有效性-实施试验，在此期间，我们将评估实施情况，同时继续测试 有效性我们将与我们的业务伙伴合作， 现有的整体健康教练，从而帮助确保可持续性。此外，目标3的结果， 审查执行工作的障碍和促进因素，将有助于指导今后的步骤。

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.