Testing the Pain Relief of musculOskeletal conditions and Arthritis using Carefully Tailored InterVEntions (PROACTIVE) Intervention: A Randomized Controlled Trial - Chronic musculoskeletal conditions and their primary source of pain, movement-evoked pain (MEP), causes significant pain interference, long-term mobility impairment, healthcare costs, and psychosocial inequalities for individuals, families, communities, and society-at-large. MEP affects more adults in later life and is perceived as more severe than resting pain. Many older adults hesitate to use opioids and non-steroidal antiinflammatory drugs long-term and rely on non-pharmacological pain self-management (SM) strategies. Current studies of chronic musculoskeletal pain (CMP) SM interventions do not measure MEP as a primary endpoint nor address faith/spirituality, varied traditions, and underlying potentially modifiable health indicators (e.g., health literacy, financial hardship), and therefore only offer small or no benefit over control conditions. We propose to enhance older adults’ capacity to manage MEP by investigating the effects of a tailored pain SM intervention (Pain Relief for musculOskeletal conditions and Arthritis using Carefully Tailored InterVEntions [PROACTIVE]). This prototype intervention will provide focused pain SM education with a SM resource toolkit, active prayer, and financial counseling to explain participants’ healthcare benefits for pain care. This intervention moves beyond basic tailoring and targets multiple areas for behavior change that are of importance to adults in later life. We have assembled an interdisciplinary and clinically experienced team to lead this study. We will enroll 120 adults (age 50-92 years) with CMP into a parallel group, single-blind, randomized controlled trial to test whether PROACTIVE decreases MEP (primary outcome) in the immediate post-intervention period (n= 60) (Aim 1) and over time (Sub-Aim 1a) compared to a usual care control group (n= 60). To determine efficacy, we will use state-of-the-art and real-time technologies to measure MEP as well as pain interference, pain coping, and physical function (secondary outcomes) (Sub-Aim 1b). The PROACTIVE group will work with a nurse and financial counselor over four weeks to enhance knowledge of CMP SM, utilization of active prayer and faith, and financial literacy of health insurance benefits and resources available to cover treatments for pain. Each weekly session will last up to 2 hours and will be followed by six days of ecological momentary assessments of pain and SM outcomes and ecological momentary interventions guiding participants through weekly SM skills. A fourth booster session will reinforce content and training and help sustain SM. Also, we will examine the differential effects of PROACTIVE on MEP according to demographic and psychosocial factors (Aim 2). The proposed intervention is expected to produce meaningful reductions in MEP in aging adults experiencing disabling chronic musculoskeletal conditions. Ideally, this study will identify precision behavior targets and responders to inform intervention refinement.
