- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04330365
Pragmatic Trial of WHT vs. PC-GE to Promote Non-Pharmacological Strategies to Treat Chronic Pain in Veterans (wHOPE)
October 21, 2020 updated by: Karen Seal, San Francisco Veterans Affairs Medical Center
Implementation of a Pragmatic Trial of Whole Health Team vs. Primary Care Group Education to Promote Non-Pharmacological Strategies to Improve Pain, Functioning, and Quality of Life in Veterans
The overarching goal of this Pain Management Collaboratory Demonstration project is to test a new Whole Health paradigm for chronic pain care, emphasizing non-pharmacological pain self-management that is hypothesized to reduce pain symptoms and improve overall functioning and quality of life in Veterans.
In UH3 Aim 1, the investigators will conduct a 12-month pragmatic effectiveness trial at 5 VA sites across the country to test whether veterans with moderate to severe chronic pain randomized to receive the Whole Health Team (WHT) intervention are more likely than those receiving Primary Care Group Education (PC-GE) to: Hypothesis 1: Experience improved pain interference (primary outcome), pain intensity, functioning and quality of life (secondary outcomes); Hypothesis 2: Decrease use of higher-risk pain medications, including opioids, or high-risk combinations; Hypothesis 3: Engage in a greater number of non-pharmacological pain management activities; and Hypothesis 4: Experience improved mental health-related symptoms, including sleep problems and suicidality.
In addition, both the WHT and PC-GE arms will be compared to a third group of veterans randomized to Usual Primary Care (UPC, Control) on the same primary and secondary outcomes above.
After the baseline assessment, masked telephone assessments will be administered to participants at 3, 6, 9, and 12 months.
UH3 Aim 2 is to conduct a process evaluation of the two active interventions (WHT and PC-GE) and a budget impact analysis that includes costs to implement and execute the two active interventions as well as the control condition (UPC) to inform the development of an implementation toolkit for scaling and dissemination.
Eligible participants are veterans reporting moderate to severe chronic pain present every day or nearly every day for ≥ 6 months.
The total sample size for the population is based on our main study aim/hypothesis and is N=745.
This breaks down to n=341 in each of the active interventions (WHT and PC-GE) and N=63 in the Usual Primary Care arm (Control).
Results of this UG3/UH3 Pain Management Collaboratory Demonstration project will contribute to the overall mission of the NIH/VA/DoD initiative to build national-level infrastructure that supports non-pharmacologic pain management in veterans and military service personnel.
Study Overview
Status
Recruiting
Conditions
Study Type
Interventional
Enrollment (Anticipated)
745
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Akshaya Krishnaswamy, MPH
- Phone Number: 415-900-8196
- Email: akshaya.krishnaswamy@va.gov
Study Contact Backup
- Name: Nicole McCamish, MA
- Phone Number: 415-676-1547
- Email: nicole.mccamish@va.gov
Study Locations
-
-
California
-
San Francisco, California, United States, 94121
- Recruiting
- SFVAHCS
-
Contact:
- Travis Ramirez
- Phone Number: 415-917-9832
- Email: travis.ramirez@va.gov
-
Principal Investigator:
- Karen H Seal, MD
-
-
Missouri
-
Saint Louis, Missouri, United States, 63125
- Recruiting
- VA St. Louis Health Care System
-
Contact:
- Lei Guo
- Phone Number: 314-939-8097
- Email: lei.guo@va.gov
-
Principal Investigator:
- Theresa Van Iseghem, PHD
-
-
Oregon
-
Portland, Oregon, United States, 97239
- Recruiting
- VAPHCS
-
Principal Investigator:
- Benjamin Morasco, PHD
-
Contact:
- Melissa Adams
- Phone Number: 57415 503-220-8262
- Email: melissa.adams@va.gov
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
Yes
Genders Eligible for Study
All
Description
Inclusion Criteria:
Participants must meet the following inclusion criteria to be enrolled in the study:
- Assigned to a VA PCP;
- Report pain present every day or nearly every day for ≥ 6 months using a phone eligibility screener; and
- PEG score of ≥ 5 (including at baseline assessment)
Exclusion Criteria:
Candidates with any of the exclusion criteria at baseline will be excluded from study participation:
- Moderate or severe cognitive impairment as determined by a failed 6-item, validated cognitive screener on initial phone screening (See Appendix A: Telephone Eligibility Screen/Script);
- Active suicidality as determined by medical record review, standardized assessment (PHQ-9) and/or is unable to attend study visits because of an unstable or severe psychiatric or medical condition or is receiving palliative or hospice care; or
- Any other factors that would interfere with study participation including inability to communicate by telephone, VTEL or VVC; being a non-English speaker; plans to relocate within 12 months and concurrent participation in another pain-related study.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Whole Health Team (WHT) Intervention Arm
The WHT intervention arm includes four core elements: 1) An interdisciplinary WHT collaborating with primary care; 2) Personalized Health Planning with prioritization of multi-modal non-pharmacological and CIH pain management approaches; 3) Whole Health Coaching sessions to assist patients in developing and implementing a Personalized Health Plan for chronic pain care; and 4) the web/mobile Whole Health Resource Directory provided to patient participants (in addition to their providers) to support non-pharmacologic/CIH chronic pain care.
|
Participants will be randomly assigned at the individual level to either WHT, PC-GE or Usual Primary Care, stratified by site, sex, and use of prescribed opioids for chronic pain.
The follow-up period for the three arms will be 12 months.
The primary outcome is change in pain interference.
Secondary outcomes include change in pain intensity, functioning, quality of life, changes in use of pain medications, including opioids (if applicable) and changes in nonpharmacological pain self-management activities.
After the baseline assessment, masked telephone assessments will be administered to participants at 3, 6, 9, and 12 months.
|
Active Comparator: Primary Care Group Education (PC-GE) Intervention Arm
Primary Care Group Education (PC-GE) iss the comparator arm, which is an abbreviated form of Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) adapted for group use in primary care.
|
Participants will be randomly assigned at the individual level to either WHT, PC-GE or Usual Primary Care, stratified by site, sex, and use of prescribed opioids for chronic pain.
The follow-up period for the three arms will be 12 months.
The primary outcome is change in pain interference.
Secondary outcomes include change in pain intensity, functioning, quality of life, changes in use of pain medications, including opioids (if applicable) and changes in nonpharmacological pain self-management activities.
After the baseline assessment, masked telephone assessments will be administered to participants at 3, 6, 9, and 12 months.
|
Placebo Comparator: Usual Primary Care (UPC) Arm
In VA, patient-aligned care teams (PACTs) or primary care is step 1 of VA's Stepped Care Model in the treatment of chronic pain.
PCPs are expected to possess the requisite skill set for management of common chronic pain-causing conditions, which includes biopsychosocial assessment, multi-modal treatment, and coordination of specialty pain care after shared-decision making that incorporates patient preferences and values.
Participants randomized to this arm will continue to have their PCP and PACT serve in this role.
|
Participants will be randomly assigned at the individual level to either WHT, PC-GE or Usual Primary Care, stratified by site, sex, and use of prescribed opioids for chronic pain.
The follow-up period for the three arms will be 12 months.
The primary outcome is change in pain interference.
Secondary outcomes include change in pain intensity, functioning, quality of life, changes in use of pain medications, including opioids (if applicable) and changes in nonpharmacological pain self-management activities.
After the baseline assessment, masked telephone assessments will be administered to participants at 3, 6, 9, and 12 months.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Improved pain interference
Time Frame: 12 months
|
The total Brief Pain Inventory (BPI) interference sub-scale score is our primary outcome measure.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Improved pain intensity
Time Frame: 12 months
|
Pain intensity rating contained in the 3-item PEG and Brief Pain Inventory (BPI).
|
12 months
|
Decreased use of higher-risk pain medications, including opioids or high-risk combinations of pain medications (i.e., co-prescription of opioids and benzodiazepines)
Time Frame: 12 months
|
The investigators will utilize the VA administrative data/databases to obtain information on prescription medications, including generic name, dispensing information, dose, and instructions.
|
12 months
|
Engagement in a greater number of non-pharmacological pain management activities
Time Frame: 12 months
|
Past-year use of complementary therapies and self-management practices will be measured using the Nonpharmacological and Self-Care Approaches from PMC (NSCAP)185.
The inventory assesses use of several CIH modalities such as yoga, etc.
The investigators will also probe for other self-directed pain management activities.
|
12 months
|
Improvement in mental health-related symptoms, including sleep problems and suicidality
Time Frame: 12 months
|
The investigators will assess sleep and fatigue symptoms using the PROMIS - Sleep Disturbance.
The investigators will be screening for suicidality using the PHQ-9.
|
12 months
|
Functioning and quality of life
Time Frame: 12 months
|
The investigators will assess functioning and quality of life using the THE VETERANS RAND 12-ITEM HEALTH SURVEY (VR-12)
|
12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
September 15, 2020
Primary Completion (Anticipated)
December 31, 2023
Study Completion (Anticipated)
December 31, 2023
Study Registration Dates
First Submitted
March 23, 2020
First Submitted That Met QC Criteria
March 30, 2020
First Posted (Actual)
April 1, 2020
Study Record Updates
Last Update Posted (Actual)
October 23, 2020
Last Update Submitted That Met QC Criteria
October 21, 2020
Last Verified
October 1, 2020
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- UH3AT009765 (U.S. NIH Grant/Contract)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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