Comparing Strategies to Improve Non-Pharmacologic Pain Relief for Adults With Back Pain Using the Education, Navigated Care, and Supported Self-management Pain Care Program (ENCompaSS)

Comparing Strategies to Improve Non-Pharmacologic Pain Relief for Adults With Back Pain (The ENCompaSS Trial)

The goal of this clinical trial is to help Veterans manage high-impact chronic low back pain. The trial will use a program, ENCompaSS (Education, Navigated Care, and Supported Self-Management) designed to reduce pain more than usual care alone. Researchers will assess a) the impact of ENCompaSS, b) identify which Veterans benefit the most, and c) how this program can be delivered more broadly in other clinics and health systems.

What Will Happen:

Veterans in this clinical trial will be randomly placed into one of two groups.

ENCompaSS group (intervention):

• Have at least three phone calls with a trained clinician over about 12 weeks
• Watch short online videos about managing pain
• Complete surveys before the study and again at 2, 4, 6, and 12 months

Usual care group:

• Will continue with regular care
• Complete the same surveys at the same time points

Study Overview

• Status: Not yet recruiting
• Conditions: Chronic Low-back Pain (cLBP); High-Impact Chronic Pain (HICP)
• Intervention / Treatment: Other: ENCompaSS (Education, Navigated Care, and Supported Self-Management) pain care program with usual care

Detailed Description

ENCompaSS (Education, Navigated Care, and Supported Self-Management), is a type I hybrid effectiveness-implementation trial conducted within three Veterans Heath Administration (VHA) systems. The intervention is a patient-centered, navigator-assisted program designed to inform and guide Veterans on non-pharmacologic treatment options.

The total study duration, including enrollment and follow-up, is approximately 30 months. A total of 530 Veterans with high-impact chronic pain (HICP) due to low back pain (LBP) will be enrolled and randomized in a 1:1 ratio to receive either the ENCompaSS intervention or usual stepped care within the VA health system. In keeping with the pragmatic design, participating VHA sites will receive standardized training and implementation support but will deliver the intervention using their existing clinical staff and resources.

Patient-reported outcomes will be collected via telephone-administered REDCap surveys at baseline and at 2, 4, 6, and 12 months post-randomization. The primary outcome will be assessed at 6 months, with additional follow-up to evaluate longer-term effects 12 months post randomization.

• Study Type: Interventional
• Enrollment (Estimated): 530
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27705
      • Durham VA

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Be age 18 years old or older
• Have a VA outpatient clinic visit for low back pain within the previous 30 days
• Be enrolled in a participating primary care clinic
• Have high impact chronic pain per Graded Chronic Pain Scale (most days or every day on first 2 items)
• Valid telephone access
• Ability to provide informed consent

Exclusion Criteria:

• Are currently hospitalized or residing in a nursing home
• Have cognitive impairment or lack of decision-making capacity
• Have a serious mental illness (e.g., schizophrenia, bipolar disorder, recent psychiatric hospitalization, high risk suicide flag)
• Are unable to communicate by telephone or have no telephone access

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: ENCompaSS + Usual Va Care; The ENCompaSS trial builds on pain navigation and management by integrating: Structured pain education; Shared decision making using the OPTIONS decision aid; Facilitated referrals to preferred non pharmacologic treatments; Supported self-management (goal setting, problem solving, self-efficacy); Asynchronous educational videos and optional SMS communication Veterans randomized to ENCompaSS receive at least three structured navigator-led phone sessions over 12 weeks, delivered by trained clinicians (e.g., nurses, physical therapists, health coaches) using existing VA resources.	Other: ENCompaSS (Education, Navigated Care, and Supported Self-Management) pain care program with usual care; The ENCompaSS pain program was designed based on the Chronic Care Model (CCM), a widely used framework for organizing care for people with chronic diseases. In this model, the care provided for a chronic condition (high impact LBP) intentionally brings together the patient, provider, and system interventions necessary to accomplish the overall goal of improving pain outcomes and related co-morbidities. Our previous experiences with navigation in a previous study were only partially represented in the CCM. ENCompaSS employs a more comprehensive blend of CCM elements, incorporating important domains such Self-Management Support, which we posit will result in better pain interference outcomes.
No Intervention: VA Usual Care; Participants randomized to usual care alone will receive standard pain treatment modalities employed within the VA Health Care System as directed by their treating providers. VA Usual care is guided by the Stepped Care Model for Pain Management (SCM-PM) which was implemented system-wide in 2009 through VHA Directive 2009-053. The SCM-PM is a tiered approach that begins with the least intensive and most accessible treatments, progressing to more specialized and intensive interventions as needed. Key components include initial assessment and management in primary care, with referrals to specialists in pain medicine, physical medicine, rehabilitation, and behavioral health when primary care interventions are insufficient. VA usual care participants will receive study materials to orient them to their treatment arm and provide assessment at multiple time points but will not receive any specific information or intervention related to LBP other than what normally would be provided.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain interference with normal activities as assessed by PROMIS (Patient-Reported Outcomes Measurement Information System) Short Form 8a v1.0 score	The validated PROMIS Pain Interference instrument measures the self-reported consequences of pain across aspects of life including social, cognitive, emotional, physical, and recreational activities. The pain interference form asks the participant to rate a series of pain related questions on a scale of 1-5 within the past seven days with 1 representing a better outcome. Ratings are summed across the four questions and converted to a standardized T-score (mean 50, standard deviation 10) according to PROMIS Scoring tables. A higher score indicates greater pain interference.	From enrollment to 6 Months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sleep quality assessed by the PROMIS 4-item short form	The sleep disturbance form asks the participant to rate a series of sleep related questions on a scale of 1-5 with 1 representing a better outcome. Ratings are summed across the four questions and converted to a standardized T-score (mean 50, standard deviation 10) according to PROMIS Scoring tables. A higher score indicates greater sleep disturbance.	Baseline to 6 Months
Physical function assessed by the PROMIS 4-item short form	The physical function form asks the participant to rate a series of physical function related questions on a scale of 1-5 within the past seven days with 1 representing a better outcome. Ratings are summed across the four questions and converted to a standardized T-score (mean 50, standard deviation 10) according to PROMIS Scoring tables. A higher score indicates better physical function.	Baseline to 6 Months
Pain intensity assessed by the PROMIS short form	Pain intensity is a standardized, 3-question survey used to quantify how much a patient is hurting. It evaluates three parameters: average pain in the past 7 days, worst pain in the past 7 days, and current pain. Patients receive a raw total score ranging from 3 to 15, where higher scores indicate greater pain severity.	Baseline to 6 Months
Depression assessed by the PROMIS 4-item short form	The depression form measures self-reported negative mood, feelings of worthlessness, and loss of interest over the past seven days on a scale of 1-5 with 1 representing a better outcome. Ratings are summed across the four questions and converted to a standardized T-score (mean 50, standard deviation 10) according to PROMIS Scoring tables. A higher score indicates more depression.	Baseline to 6 Months
Anxiety assessed by the PROMIS 4-item short form	The anxiety form measures self-reported anxiety, fear, and hyperarousal over the past seven days on a scale of 1-5 with 1 representing a better outcome. Ratings are summed across the four questions and converted to a standardized T-score (mean 50, standard deviation 10) according to PROMIS Scoring tables. A higher score indicates more anxiety.	Baseline to 6 Months
Pain-related ED visits by the VA electronic health record (EHR)	Emergency Department (ED) visits for pain measured using ICD coding for VA and Non-VA visits.	12 Months post randomization
Non-pharmacologic pain care visits by the VA EHR	Visits for pain with non-prescribing providers using ICD coding.	6 Months and 12 Months post randomization

Collaborators and Investigators

• Sponsor: Duke University
• Collaborators: Indiana University; University of Arizona; Dallas VA Medical Center; Durham VA Medical Center
• Investigators: Principal Investigator: Susan Hastings, MD, Duke University

Study record dates

Study Major Dates

• Study Start (Estimated): October 1, 2026
• Primary Completion (Estimated): July 31, 2029
• Study Completion (Estimated): July 31, 2029

Study Registration Dates

• First Submitted: June 25, 2026
• First Submitted That Met QC Criteria: June 25, 2026
• First Posted (Actual): July 1, 2026

Study Record Updates

• Last Update Posted (Actual): July 1, 2026
• Last Update Submitted That Met QC Criteria: June 25, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Low Back Pain; Veterans; Pain Management; Clinical Pathway; Non-Pharmacologic
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Back Pain; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Low Back Pain; Agnosia; Socioeconomic Factors; Population Characteristics; Educational Status
• Other Study ID Numbers: Pro00120495; BPS-2024-40339 (Other Grant/Funding Number: Patient-Centered Outcomes Research Institute (PCORI))

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

Study data sets will be shared a timely manner with privacy and confidentiality protections to facilitate further research, reuse of data, and replication. Publications from this research will be made available to the public through the National Library of Medicine PubMed Central website. To enable broad resource sharing, the study statistician will create de-identified, publication-specific datasets including all variables presented in the publication.

The PIs hold responsibility for ensuring that the individuals cannot be re-identified. No data or code that could lead to re-identification of individuals will be released. The analytical datasets and statistical code used will be retained in accordance with VA record retention policy. If successful outcomes justify broader dissemination, we will seek to do so by placing relevant materials into the public domain.

• IPD Sharing Time Frame: The data and other resources referenced will be available one year after the date of publication for the primary analyses, which is in alignment with the VA Office of Research and Development.

IPD Sharing Access Criteria

We plan on using a de-identified dataset and is not subject to HIPAA's minimum necessary standards and would not require a data use agreement. Typically, datasets will be provided in SAS transport files using CDISC standards via a website. Requesters will have to enter a valid email, phone number and address to request data. The data provided will be made available under certain requirements and approved on a case-by-case basis.

Requirements include:

• Data will be used for research purposes and not to identify subjects
• Data must be secured using appropriate computer technology
• Data must be destroyed or returned after any analysis are complete authors of any manuscript resulting from this data must acknowledge the source of the data
• Analyses for the purpose of presentations, abstracts, and/or publications must be coordinated through the Publications Committee, to avoid overlap
• Coauthors must be given a chance for review and approval of a draft manuscript prior to submission

• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No