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Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) - Protocol for a pragmatic cluster randomized trial.

Publication ,  Journal Article
DeBar, L; Benes, L; Bonifay, A; Deyo, RA; Elder, CR; Keefe, FJ; Leo, MC; McMullen, C; Mayhew, M; Owen-Smith, A; Smith, DH; Trinacty, CM; Vollmer, WM
Published in: Contemp Clin Trials
April 2018

BACKGROUND: Chronic pain is one of the most common, disabling, and expensive public health problems in the United States. Interdisciplinary pain management treatments that employ behavioral approaches have been successful in helping patients with chronic pain reduce symptoms and regain functioning. However, most patients lack access to such treatments. We are conducting a pragmatic clinical trial to test the hypothesis that patients who receive an interdisciplinary biopsychosocial intervention, the Pain Program for Active Coping and Training (PPACT), at their primary care clinic will have a greater reduction in pain impact in the year following than patients receiving usual care. METHODS/DESIGN: This is an effectiveness-implementation hybrid pragmatic clinical trial in which we randomize clusters of primary care providers and their patients with chronic pain who are on long-term opioid therapy to 1) receive an interdisciplinary behavioral intervention in conjunction with their current health care or 2) continue with current health care services. Our primary outcome is pain impact (a composite of pain intensity and pain-related interference) measured using the PEG, a validated three-item assessment. Secondary outcomes include pain-related disability, patient satisfaction, opioids dispensed and health care utilization. An economic evaluation assesses the resources and costs necessary to deliver the intervention and its cost-effectiveness compared with usual care. A formative evaluation employs mixed methods to understand the context for implementation in the participating health care systems. DISCUSSION: This trial will inform the feasibility of implementing interdisciplinary behavioral approaches to pain management in the primary care setting, potentially providing a more effective, safer, and more satisfactory alternative to opioid-based chronic pain treatment. Clinical Trials Registration Number: NCT02113592.

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Published In

Contemp Clin Trials

DOI

EISSN

1559-2030

Publication Date

April 2018

Volume

67

Start / End Page

91 / 99

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Recovery of Function
  • Quality of Life
  • Public Health
  • Primary Health Care
  • Pragmatic Clinical Trials as Topic
  • Patient Preference
  • Patient Care Team
  • Pain Measurement
  • Pain Management
 

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DeBar, L., Benes, L., Bonifay, A., Deyo, R. A., Elder, C. R., Keefe, F. J., … Vollmer, W. M. (2018). Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) - Protocol for a pragmatic cluster randomized trial. Contemp Clin Trials, 67, 91–99. https://doi.org/10.1016/j.cct.2018.02.015
DeBar, Lynn, Lindsay Benes, Allison Bonifay, Richard A. Deyo, Charles R. Elder, Francis J. Keefe, Michael C. Leo, et al. “Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) - Protocol for a pragmatic cluster randomized trial.Contemp Clin Trials 67 (April 2018): 91–99. https://doi.org/10.1016/j.cct.2018.02.015.
DeBar, Lynn, et al. “Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) - Protocol for a pragmatic cluster randomized trial.Contemp Clin Trials, vol. 67, Apr. 2018, pp. 91–99. Pubmed, doi:10.1016/j.cct.2018.02.015.
DeBar L, Benes L, Bonifay A, Deyo RA, Elder CR, Keefe FJ, Leo MC, McMullen C, Mayhew M, Owen-Smith A, Smith DH, Trinacty CM, Vollmer WM. Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) - Protocol for a pragmatic cluster randomized trial. Contemp Clin Trials. 2018 Apr;67:91–99.
Journal cover image

Published In

Contemp Clin Trials

DOI

EISSN

1559-2030

Publication Date

April 2018

Volume

67

Start / End Page

91 / 99

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Recovery of Function
  • Quality of Life
  • Public Health
  • Primary Health Care
  • Pragmatic Clinical Trials as Topic
  • Patient Preference
  • Patient Care Team
  • Pain Measurement
  • Pain Management