Partners for Pain & Wellbeing Equity: A Randomized Trial of Community Supported Complementary and Integrative Health Self Management for Back Pain

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PROJECT SUMMARY. Back pain (BP), including low back and neck pain, is one of the most prevalent and disabling pain disorders. Most cases remain poorly managed and known socio-ecological factors that pose barriers to equitable care have been especially under-addressed resulting in critical disparities in BP management. This is evidenced by Black and Hispanic Americans, and individuals with less education and income, consistently experiencing poorer outcomes. Importantly, BP, like other chronic conditions, requires ongoing self-management. Unfortunately, most care offered through health systems fails to support sufferers’ self-care, and instead focuses on costly and provider-dependent therapies with little supporting research evidence. The persistent use of these practices contradicts evidence-based BP guideline recommendations for less invasive complementary and integrative health (CIH) approaches which can support self-care. Importantly, our team has demonstrated CIH approaches can be safely and effectively delivered in non-clinical settings in both in person and video-conferencing formats which can overcome barriers contributing to disparities. The long-term objective is to bolster the widespread implementation of evidence-based CIH approaches that support whole person oriented, self-care for individuals with back pain and who are from populations that experience health disparities (BP-PEHD). We will use a two-phase project that applies established models and frameworks for facilitating long term sustainability to develop, feasibility test, and evaluate the effectiveness of a community supported CIH self- management program, Partners4Pain compared to an active control, Keys to Wellbeing. This project builds upon our team’s extensive background in BP and CIH self-management research and established partnerships with community and health organizations with broad and diverse reach including the YMCA, YWCA, and others. Phase I (R61) will involve planning and preparations leading to a randomized feasibility study (n=40) including co- development and assessment of Partners4Pain, a self-management program comprised of evidence based CIH approaches (e.g. pain education, mindfulness, cognitive behavioral/pain coping strategies, exercise). Phase II (R33) includes a full-scale multi-level randomized hybrid effectiveness implementation trial (n=376) of the community supported self-management program, Partners4Pain compared to the active control, Keys to Wellbeing, both of which will have been optimized and feasibility tested in Phase I. By co-developing scalable evidence based CIH interventions with community stakeholders that can be delivered in an accessible manner by community partner organizations with extensive reach, we will remove an important barrier that currently exists within the costly and burdensome health care systems. This approach has the potential for larger scale implementation across a range of community-based organizations and settings, improving equitable access to resources that will support BP sufferers’ ability to gain greater agency in their own pain care, leading to better health and wellbeing.