Taking ACTION to Reduce Pain: a Randomized Clinical Trial of a Walking-Focused, Proactive Coaching Intervention for Black Patients with Chronic Musculoskeletal Pain

• Type of Material: Article
• Authors: Diana J. Burgess, University of Minnesota, Minneapolis; Emily Hagel Campbell, Veterans Affairs Medical Center, Minneapolis; Patrick Hammett, University of Minnesota, Minneapolis; Kelli D. Allen, University of North Carolina, Chapel Hill; Steven S. Fu, University of Minnesota, Minneapolis; Alicia Heapy, Yale University; Robert D. Kerns, Yale University; Sarah L. Krein, University of Michigan, Ann Arbor; Laura A. Meis, University of Minnesota, Minneapolis; Ann Bangerter, Veterans Affairs Medical Center, Minneapolis; Lee J.S. Cross, Veterans Affairs Medical Center, Minneapolis; Tam Do, Veterans Affairs Medical Center, Minneapolis; Michael Saenger, Emory University; Brent C. Taylor, University of Minnesota, Minneapolis
• Language: English
• Date: 2022-02-07
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © 2022, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply
• Final Published Version (URL): https://doi.org/10.1007/s11606-021-07376-2
• Title of Journal or Parent Work: Journal of General Internal Medicine
• Volume: 37
• Issue: 14
• Start Page: 3585
• End Page: 3593
• Grant/Funding Information: This work was supported by a Merit Review Award (IIR no. 13-030) from the United States (U.S.) Department of Veterans Affairs Health Services Research and Development Service.
• Keywords: African Americans; walking; vulnerable populations; chronic pain
• Research Categories: Health Sciences, General; Health Sciences, Public Health

Abstract

Background Black patients in the USA are disproportionately affected by chronic pain, yet there are few interventions that address these disparities. Objective To determine whether a walking-focused, proactive coaching intervention aimed at addressing contributors to racial disparities in pain would improve chronic pain outcomes among Black patients compared to usual care. Design Randomized controlled trial with masked outcome assessment (Clinicaltrials.gov: NCT01983228). Participants Three hundred eighty Black patients at the Atlanta VA Health Care System with moderate to severe chronic back, hip, or knee pain. Intervention Six telephone coaching sessions over 8–14 weeks, proactively delivered, using action planning and motivational interviewing to increase walking, or usual care. Main Measures Primary outcome was a 30% improvement in pain-related physical functioning (Roland Morris Disability Questionnaire [RMDQ]) over 6 months among Black patients, using intention-to-treat. Secondary outcomes were improvements in pain intensity and interference, depression, anxiety, global impression of change in pain, and average daily steps. Key Results The intervention did not produce statistically significant effects on the primary outcome (at 6 months, 32.4% of intervention participants had 30% improvement on the RMDQ vs. 24.7% of patients in usual care; aOR=1.61, 95% CI, 0.94 to 2.77), nor on other secondary outcomes assessed at 6 months, with the exception that intervention participants reported more favorable changes in pain relative to usual care (mean difference=−0.54, 95% CI, −0.85 to −0.23). Intervention participants also experienced a significant reduction in pain intensity and pain interference over 3 months (mean difference=−0.55, 95% CI, −0.88 to −0.22). Conclusions A novel intervention to improve chronic pain among Black patients did not produce statistically significant improvements on the primary outcome relative to usual care. More intensive efforts are likely required among this population, many of whom were economically disadvantaged and had mental health comorbidities and physical limitations.