Holistic Pain Care in Military Health System - PROJECT SUMMARY Chronic pain is a ubiquitous problem and growing concern for the Military Health System (MHS). Chronic musculoskeletal (MSK) pain are the most common chronic pain conditions in the MHS. Numerous recommendations have been made to improve care for chronic MSK pain in the MHS. Important recommendations informing this project include; 1) the Office of the Army Surgeon General is promoting transition of the MHS to a holistic health system that seeks to maintain, restore and improve health through team-based care supporting self-management and recognizing the complex, biopsychosocial nature of chronic pain; and 2) a stepped care approach to pain management is advocated to make less intense, but effective, first-line care broadly available and basing subsequent care on response to first-line options. While the MHS has articulated its vision for holistic pain care delivered within a stepped care framework, there is a need for research addressing key questions about which interventions are most effective and how to operationalize the stepped care model. In addition, pragmatic, sustainable, strategies to implement holistic pain care in the MHS are needed. Electronic health records (EHR) are increasingly used to implement evidence-based interventions, but have not been widely tested in the MHS. The MHS has deployed a new system-wide EHR with standards-based capabilities for decision-support, making EHR-based implementation a timely option with high potential for Future scalability. Our goal in this project is to improve pain care in the MHS by identifying effective, whole-person, nonpharmacologic interventions for persons with chronic MSK pain. We will evaluate two promising, evidence-based interventions; Empowered Relief (ER) and Move-to-Health (M2H). We will compare these interventions to one another and to usual care (UC). We will also test a stepped care strategy of providing ER first, followed by M2H for non-responders. The current environment and policy priorities in the Department of Defense and MHS makes this the ideal time to evaluate holistic pain interventions and test strategies for stepped care delivery. Our project has two Phases: 1) a UG3 Planning Phase, and 2) a UH3 Clinical Trial Phase. In the UG3 phase the plans for implementation across MHS sites will be completed and all necessary preparations will be made for the clinical trial. In the UH3 phase we will conduct a hybrid type-I, individually-randomized pragmatic clinical trial comparing M2H vs. ER vs. UC as first-line pain interventions, and examining a stepped care strategy of providing ER first, followed by M2H for non-responders. We will use EHR-based strategies to connect patients with chronic MSK pain in primary care clinics with the holistic pain management strategies. The primary outcome will be the PEG measure of pain impact. Secondary outcomes will include additional effectiveness measures as well as implementation outcomes grounded in a RE-AIM framework.
