Chronic pain is a ubiquitous problem and growing concern for society, contributing substantially to the ongoing opioid epidemic. Back pain is the most common chronic pain diagnosis and the most common diagnosis for which opioids are prescribed. Clinical practice guidelines and opioid-prescribing recommendations make it clear that nonpharmacologic pain treatments are preferable to opioids for patients with back pain. Despite unequivocal evidence, over-prescribing of opioids to individuals with back pain persists. Primary care providers serving rural and low income communities face specific challenges to providing nonpharmacologic pain care instead of over-reliance on opioids. Providers of nonpharmacologic care are often absent from these communities and even if present may be inaccessible to patients with limited financial resources. Many rural and low income communities are served by federally-qualified health centers (FQHCs). FQHCs often serve communities at the forefront of the opioid crisis but too often lack options to provide accessible nonpharmacologic alternatives to the patients they serve. This Project describes a 1-year planning phase followed by a 4-year clinical trial that will compare the effectiveness of different strategies to provide efficacious nonpharmacologic interventions to patients with back pain seeking care in FQHCs throughout the state of Utah. The strategies evaluated are designed to overcome the barriers specific to rural and low income communities served by FQHC clinics through innovative use of telehealth resources. The randomized clinical trial will evaluate two interventions strategies, one providing both a brief pain teleconsult with phone-based physical therapy, the other uses an adaptive strategy ? providing the brief pain teleconsult first, followed by phone-based physical therapy among those non-responsive to this treatment. We will also evaluate outcomes related to the efforts to implement strategies in FQHC clinics in order to provide valuable information for future efforts to scale effective strategies into other low resource health care settings. Our clinical trial has 4 Specific Aims: 1) compare the effectiveness of a pain teleconsult intervention with or without phone-based physical therapy for patients with chronic back pain in FQHCs, 2) compare the effectiveness of different 2-phase treatment strategies in which phone-based physical therapy is considered either a first-line or second-line option, 3) examine the results for Aims 1 & 2 in pre-specified sub- groups of patients based on baseline characteristics, and 4) examine implementation outcomes of the pain teleconsult including acceptability, adoption, feasibility and fidelity.
Chronic pain is at the heart of the opioid epidemic and back pain is the most common condition leading to chronic pain. Improving back pain management and reducing disparities are important considerations in reducing the opioid crisis and improving the lives of impacted individuals. The goal of this project to identify effective strategies for providing nonpharmacologic alternatives to opioid pain management for patients with back pain in low income and rural communities using telehealth solutions.
