The VHA has identified pain management as a high priority. Data document that perhaps a majority of Veterans receiving care in VHA, including OEF/OIF/OND [[and women]] Veterans, report the presence of pain. CLBP, in particular, is among the most prevalent and costly of all disorders treated in VHA. Among the most promising therapies for reducing pain and improving functioning among persons with CLBP are low cost and low risk non-pharmacological interventions such as exercise and behavioral interventions. Despite evidence supporting their effectiveness, access barriers often prevent Veterans from receiving these interventions. A growing body of evidence suggests that behavioral interventions, including those for persons with CLBP, can be delivered successfully via the Internet. Development of a viable Internet-based delivery platform to facilitate Veteran access to such interventions for CLBP offers an important solution to several access barriers. Within VHA, the availability of MyHealtheVet offers an ideal platform for hosting a pain self-management intervention. The primary objectives of the proposed study are to: (1) develop an integrative, Internet-based, Veteran-centered behavioral intervention, the Veteran Pain Management Resource Center (VPMRC) for CLBP, and (2) examine preliminary efficacy, usability, and satisfaction of this intervention in a representative sample of Veterans with CLBP. To achieve these objectives, a [[24-month]] pilot study with two phases is proposed. During Phase I, the VPMRC will be developed and feedback from 15 Veterans with CLBP and an Expert Panel of pain management clinicians will be used to modify the program. As currently envisioned, the VPMRC will serve as a resource to help Veterans learn and practice adaptive behavioral and cognitive pain coping skills such as relaxation and stress reduction methods, exercise and structured physical activity, and activity pacing, among others. During Phase II, a pilot feasibility trial of the VPMRC will be conducted to test the preliminary efficacy and usability of, and satisfaction with the VPMRC. Fifty-five Veterans with CLBP will be recruited for Phase II. All participants will continue to receive their usual care from VHA providers. During [[the 10-week]] therapeutic window, weekly telephone calls from research staff will serve to cue and monitor participants' use of the Internet program. At [[ten]] weeks post-baseline, participants will be formally reassessed. Planned statistical analyses will test the hypothesis that Veterans who engage in the VPMRC program will demonstrate a clinically meaningful reduction in pain-related functional interference as measured by a 0.6 point decrease in individual scores on the West Haven-Yale Multidimensional Pain Inventory-Interference Scale, relative to baseline. Additional analyses will test whether participants are more likely to report clinically meaningful reductions in pain intensity and improvements in fatigue, sleep, and mood, relative to baseline. Participants are also hypothesized to report high levels of interest and credibility, use of, and satisfaction with the VPMRC. The Phase II quantitative outcomes data will further assist with modification and revision of the VPMRC. If the project is successful and demonstrates preliminary efficacy, further evaluation of efficacy via randomized controlled trial, followed by dissemination and implementation efforts, may increase access to pain self-management treatment and increase effectiveness of care for Veterans with CLBP.

Public Health Relevance

Chronic low back pain (CLBP) is among the most prevalent and costly disorders among Veterans receiving care in VHA facilities. Behavioral interventions such as exercise and cognitive behavior therapy are known to be effective for CLBP but are often not readily available or easily accessed. The overall objective of the proposed project is to develop and test the preliminary efficacy and usability of and satisfaction with an integrative, Internet-based, behavioral pain self-management program, the Veterans Pain Management Resource Center (VPMRC), in Veterans with CLBP. The VPMRC will be designed and built to be compatible with MyHealtheVet (MHV). If successful, the long term objective is to migrate the VPMRC to the MHV platform to provide widespread and easy access for Veterans across VHA, regardless of geography or other access barriers.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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Centers, Research Enhancement Award Program and Consortiums (RRDC)
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VA Connecticut Healthcare System
West Haven
United States
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