SBIRT (Pain Management) for Veterans Filing Compensation Claims

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DESCRIPTION (provided by applicant): This proposed project involves modifying and pilot-testing an established SBIRT intervention for Veterans being evaluated for painful musculoskeletal disorders (MSD) who are at risk for substance use disorders. The modified intervention, SBIRT-PM (Pain Management) is for Veterans who have filed a claim for a (military) service-connected injury for which they have requested financial compensation. Projections are that at least half of OEF/OIF/OND (Operations Enduring Freedom, Iraqi Freedom, New Dawn) Veterans will have some compensable service-connected condition with 140,452 already compensated for back/neck conditions and comparable numbers for other joint conditions. For a significant proportion, the disability evaluation is their first encounter with V healthcare. The disability evaluation is a perfectly-timed opportunity to enlist Veterans in a preventive intervention but this opportunity is typically missed. In our group's completed clinical trial, Veterans applying for Compensation for PTSD were able to be engaged in health-promoting activities significantly more often if they received active counseling around the time of their Compensation claim than controls, but counseling after Compensation exams has not been piloted in Veterans applying for MSD. SBIRT-PM will be delivered around the time of the Compensation examination by a counselor, with confidentiality assured. The counselor will explain that treating both physical and psychological aspects of pain leads to the best outcomes, and will outline what VA services are available to Veterans. After discussing management of pain and things that can impact pain, the counselor will then explain that while substances are sometimes used for pain relief, they can negatively impact pain control. The counselor will then segue into SBIRT. This project will involve two stages: (1) a Counseling Refinement phase during which SBIRT-PM will be pre-piloted in 20 Veterans, qualitative data will be collected immediately after counseling sessions, and the intervention's appeal to Veterans will be optimized; and (2) a randomized clinical trial in which 100 Veterans with MSD and recent risky substance use will be assigned to a No Additional Referral condition, a Pain Module Only condition, or SBIRT- PM in a 1:1:2 ratio and followed for 12 weeks. The primary outcome to be estimated is the slope of weeks with risky substance use. Secondary analyses will estimate the slope of pain intensity and the relationship of substance use and pain slopes, controlling for stage-of-change. Screening and referral to treatment at Compensation examinations can transform a widely-used point of entry to VA into a health-promoting encounter.