Tele-Collaborative Outreach to Rural Patients with Chronic Pain: The CORPs Trial

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Project Summary The overall goal of this multisite, pragmatic, randomized clinical trial is to adapt and test a tele-collaborative care intervention for chronic pain with veterans living in rural areas. During the 1-year UG3 phase, we will apply evidence-based quality improvement strategies to adapt our tele-collaborative pain care intervention for implementation across four geographically diverse VA health care facilities; pilot test and refine recruitment, intervention and data collection protocols at study sites; and, in collaboration with the Pain Management Collaboratory Coordinating Center, develop standard operating procedures for all activities to be conducted in the UH3 clinical trial phase. Engagement panels will inform adaptation of the intervention and all components of the methods of the clinical trial. During the 4-year UH3 phase, we will implement and evaluate the intervention among rural veterans with high impact chronic pain in a 12-month pragmatic effectiveness trial. We plan to recruit 152 veterans from each of four clinical sites (total N=608), diverse in terms of birth sex, race, and ethnicity. Participants will be randomized to receive either tele-collaborative pain care or minimally enhanced usual care. The intervention is based on the collaborative care model and includes an initial biopsychosocial chronic pain assessment with a nurse care manager, follow-up, and participation in a pain education group. The nurse care manager will receive consultation from a pain physician and participants may be referred for nonpharmacologic and complementary and integrative health treatments for chronic pain. The nurse care manager will also follow up with rural veterans and help them navigate care across VA and community health services. We hypothesize that rural veterans who receive tele-collaborative pain care, relative to minimally enhanced usual care, will evidence decreased pain severity and interference, increased physical functioning and quality of life, decreased mental health symptom severity and suicidal ideation and behavior, improved sleep, and increased utilization of nonpharmacologic and complementary and integrative health pain treatments. We further hypothesize that treatment effects will persist across female vs. male rural veterans and those who identify as white non-Hispanic vs. minoritized race or ethnicity. Finally, we will conduct an implementation process evaluation and an incremental cost-effectiveness analysis to inform development of an implementation toolkit. Study results will inform the future rollout of tele-collaborative pain care for rural veterans nationally.