Chronic pain is among the most common reasons patients seek medical treatment, and patients understandably tend to prioritize the treatment of pain over other conditions. Because pain is such a demanding condition, both physically and cognitively, it’s often only after pain is addressed that patients are able to focus on other medical issues including OUD. The central premise of our Engagement research project is that a “pain first” approach will initially engage patients by addressing their pain, and then by incorporating OUD-related content, also engage them in treatment for OUD. This project breaks new ground in three important ways:
- “Pain first” approach. PSM interventions have not been used as a method to engage individuals in OUD treatment, especially those with unrecognized or undiagnosed OUD.
- PSM for OUD. PSM interventions have not been tailored to meet the needs of individuals with OUD. To our knowledge, this has not been done in any setting, including primary care.
- Rural populations. PSM interventions have not been tailored to meet the needs of rural populations or clinics, or developed to be implemented in rural settings. To our knowledge, we will be among the first to work to fill this critical gap.
Principal Investigator: Dr. Erin Winstanley
Specific Aims
- Aim 1: Tailor evidence-based pain self-management (PSM) to primary care patients with chronic pain and opioid use disorder (OUD) (PSM-OUD). We will develop PSM-OUD using intervention mapping, a systematic, theory-based qualitative approach to tailoring interventions (e.g., PSM) to new populations. We will use the Health Equity Implementation Framework to investigate potential implementation barriers and facilitators across our sites.
- Aim 2: Compare the effect of PSM-OUD versus enhanced usual care on pain and OUD outcomes and assess implementation barriers and facilitators to PSM-OUD in primary care. We will conduct a Hybrid Type 1 multi-site, randomized controlled trial (RCT) of the effect of PSM-OUD versus enhanced usual care on pain outcomes and medication use for OUD
- Aim 3: Evaluate the cost effectiveness of PSM-OUD compared with enhanced usual care.
Research Sites
Pennsylvania
Pennsylvania recruitment sites are located in Allegheny and five surrounding counties, which include urban and rural populations. Pennsylvania is #5 in the US in age-adjusted overdose deaths (35.6/100,000) and in 2020, Allegheny County reported 586 overdose deaths, reversing a previously decreasing trend. Deaths are predominantly in white males and are driven by fentanyl and heroin. This pattern is repeated in most of the surrounding counties.
Participating Clinics: UPMC Community Medicine Inc., UPMC General Internal Medicine
Research Team: Dr. Shari Rogal (Co-PI), Dr. Jane Liebschutz (Co-I)
West Virginia
The Engagement project will recruit from 20+ clinics located across West Virginia. Central Appalachia is one of the US epicenters of the opioid epidemic and West Virginia has consistently led the US in age-adjusted opioid overdose deaths. Due to the state’s almost entirely rural composition, West Virginians face significant barriers to both addiction and chronic pain treatment.
Participating Clinics: WVU Medicine, Cabin Creek Health Systems
Research Team: Dr. Erin Winstanley (Site PI)