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Trajectories of non-pharmacologic and opioid health services for pain management in association with military readiness and health status outcomes: SUPIC renewal

Award Number: R01AT008404
ORGANIZATION: CENTER FOR DRUG EVALUATION AND RESEARCH, NIH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Summary/Abstract In 2016, the US Department of Health and Human Services released the National Pain Strategy, which outlined a coordinated plan to improve healthcare delivery for patients with pain. It outlined the need for better monitoring methods, supporting patient-centered integrated pain management practices, and improving access to effective non-pharmacological therapies (NPT). The impact of pain in civilian health care systems is mirrored in the military and veteran populations; both the Military Health System (MHS) and Veterans Health Administration (VHA) populations have a higher prevalence of chronic pain compared to civilian populations. The Medical Surveillance Monthly Report identified the top nine reasons for seeking care in the MHS outside of pregnancy services and ill-defined symptoms. Five were related to musculoskeletal (back, knee, ankle, arm) injuries or problems and the remaining top conditions were anxiety, mood/adjustment, and sleep disorders, which in some cases could be comorbidities with pain. The present study is a renewal R01 application to advance knowledge on military readiness, opioid, and health status outcomes associated with different early treatment trajectories of nondrug pain management strategies in the MHS. Investigators from the SUPIC project (Substance Use and Psychological Injury Combat R01AT008404) have generated foundational knowledge about chronic pain and its behavioral health comorbidities in the MHS. We have established a comprehensive, longitudinal database on Army members returning deployment comprised of their MHS and VHA health encounter/claims data and several other data sources. We have investigated the use of early NPT utilization (both complementary [e.g., chiropractic, acupuncture, spinal manipulation, self-management, interdisciplinary pain programs] strategies and integrative [e.g., exercise therapy, physical therapy, occupational therapy, mental health specialty care] strategies, and identified there is high prevalence of opioid medications in the chronic pain cohort. The Specific Aims of the SUPIC renewal application are to: Aim 1: (a) Characterize early trajectories of NPT and opioid therapies for pain management; (b) examine relationships between NPT utilization (e.g., specific modalities, utilization trajectories) and multidimensional outcomes (e.g., military readiness, opioid utilization, health status); and (c) investigate the relationship of NPT trajectories and outcomes in discrete high risk subgroups of patients (comorbid PTSD, depression) and for specific pain conditions (e.g., back pain, other musculoskeletal, headache). Aim 2: Identify facility- and provider-level factors (FTE availability for health occupations, propensity to refer to NPT or prescribe opioids) that explain variation in NPT use and opioid prescribing between MHS facilities. Aim 3: (a) Describe the characteristics of SUPIC Army deployed members with chronic pain in the MHS who do and do not transition to VHA care; (b) identify associations between NPT receipt in the MHS and long-term health outcomes in the VHA (main effects); and (c) identify moderators and mediators of these associations. This renewal grant is poised to efficiently continue much needed work on MHS pain management approaches that will directly inform MHS and VHA leadership and facilitate informed clinical and organizational changes. The SUPIC study population will be expanded to members of all service branches in 2013-2018 (estimated at 2 million or more) and the investigative team is expanded to strengthen our practical knowledge and facilitate rapid translation of research findings into action. Researchers from the Defense & Veterans Center on Integrative Pain Management at the Uniformed Services University, the Department of Defense’s Center of Excellence on pain strategies are joining the investigative team.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $1,081,439 )
2023	2023	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	001	10	8/30/2023	SUPPLEMENT FOR EXPANSION	$325,139
2023	2023	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	000	10	8/8/2023	NON-COMPETING CONTINUATION	$756,300
														Subtotal = $1,081,439

Issue Date FY: 2022 ( Subtotal = $768,429 )
2022	2022	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	002	9	8/9/2022	NON-COMPETING CONTINUATION	$769,739
2022	2018	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	000	5	6/29/2022	NON-COMPETING CONTINUATION	-$1,310
2022	2017	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	001	4	6/29/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $768,429

Issue Date FY: 2021 ( Subtotal = $783,477 )
2021	2021	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	001	8	9/29/2021	NON-COMPETING CONTINUATION	$0
2021	2021	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	000	8	7/9/2021	NON-COMPETING CONTINUATION	$783,477
														Subtotal = $783,477

Issue Date FY: 2020 ( Subtotal = $767,784 )
2020	2020	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	003	7	7/22/2020	NON-COMPETING CONTINUATION	$767,784
2020	2019	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	002	6	4/22/2020	COMPETING CONTINUATION	$0
2020	2019	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	001	6	1/18/2020	COMPETING CONTINUATION	$110,650
2020	2018	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	000	5	1/18/2020	NON-COMPETING CONTINUATION	-$110,650
														Subtotal = $767,784

Issue Date FY: 2019 ( Subtotal = $791,763 )
2019	2019	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	002	6	8/5/2019	COMPETING CONTINUATION	$791,763
2019	2018	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	000	5	6/12/2019	NON-COMPETING CONTINUATION	$0
2019	2018	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	001	5	8/5/2019	NON-COMPETING CONTINUATION	$0
														Subtotal = $791,763

Issue Date FY: 2018 ( Subtotal = $606,265 )
2018	2018	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	000	5	6/19/2018	NON-COMPETING CONTINUATION	$606,265
														Subtotal = $606,265

Issue Date FY: 2017 ( Subtotal = $602,396 )
2017	2017	BRANDEIS UNIVERSITY	415 SOUTH ST	WALTHAM	MA	02453	MIDDLESEX	USA	Research and Training in Complementary and Integrative Health	000	4	6/29/2017	NON-COMPETING CONTINUATION	$602,396
														Subtotal = $602,396

Issue Date FY: 2016 ( Subtotal = $595,243 )
2016	2016	BRANDEIS UNIVERSITY	415 SO ST, 119 BERNSTEIN-MARCU	WALTHAM	MA	02254		USA	Research and Training in Complementary and Integrative Health	000	3	6/9/2016	NON-COMPETING CONTINUATION	$595,243
														Subtotal = $595,243

Issue Date FY: 2015 ( Subtotal = $575,600 )
2015	2015	BRANDEIS UNIVERSITY	415 SO ST, 119 BERNSTEIN-MARCU	WALTHAM	MA	02254		USA	Research and Training in Complementary and Integrative Health	000	2	6/30/2015	NON-COMPETING CONTINUATION	$575,600
														Subtotal = $575,600

Issue Date FY: 2014 ( Subtotal = $597,504 )
2014	2014	BRANDEIS UNIVERSITY	415 SO ST, 119 BERNSTEIN-MARCU	WALTHAM	MA	02254		USA	Research and Training in Complementary and Integrative Health	000	1	8/14/2014	NEW	$597,504
														Subtotal = $597,504

Grand Total All Awards = $7,169,900

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Trajectories of non-pharmacologic and opioid health services for pain management in association with military readiness and health status outcomes: SUPIC renewal

Award Number: R01AT008404

ORGANIZATION: CENTER FOR DRUG EVALUATION AND RESEARCH, NIH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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