Peer Support Pain Self-Management for Musculoskeletal Pain

(CONNECT Trial)

Overseen By Kimberly L Selander, MA

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Life-threatening conditions, Sensory deficits, Surgery, Mental health, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 12

Duration: 8 weeks

4 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The proposed study will test the feasibility and acceptability of an 8-week home-based reciprocal peer support pain self-management intervention (CONNECT) for women Veterans with chronic musculoskeletal pain. The use of this format will improve the accessibility of treatment to women Veterans who experience logistical, healthcare delivery and psychosocial barriers to care. To address these barriers women Veterans who enroll in CONNECT will be paired and work together to learn/practice pain coping skills, set meaningful activity goals, and participate in a graduated walking program; they will exchange nightly text messages and engage in a weekly 20 minute phone call to reinforce each other and provide support for pain self-management efforts. This is a single-arm pilot project; all eligible and interested women with chronic musculoskeletal pain will receive CONNECT. The primary outcome will be post-treatment and long-term follow-up retention rates.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

Is peer support pain self-management safe for humans?

The studies on peer support interventions for pain self-management, such as those for veterans and older adults with chronic pain, do not report any specific safety concerns, suggesting it is generally safe for humans. ^{1 2 3 4 5}

How is the treatment Project CONNECT different from other treatments for musculoskeletal pain?

Project CONNECT is unique because it uses peer support to help people manage their musculoskeletal pain, which means individuals with similar experiences guide each other in pain management strategies. This approach focuses on self-management and peer interaction, rather than relying solely on medical professionals or medication. ^{1 3 6 7 8}

What data supports the effectiveness of the treatment Project CONNECT for musculoskeletal pain?

Research shows that self-management programs for musculoskeletal pain, like Project CONNECT, can lead to small but significant improvements in pain, health distress, and self-efficacy (confidence in managing one's health). These programs often involve education and peer support, which have been effective in similar settings. ^{1 3 6 9 10}

Who Is on the Research Team?

Mary Driscoll, PhD

Principal Investigator

VA Connecticut Healthcare System West Haven Campus, West Haven, CT

Are You a Good Fit for This Trial?

This trial is for women veterans with moderate to severe musculoskeletal pain, who have experienced pain on most days in the past six months. Participants must be receiving care at specified VA healthcare systems, own a cell phone, and be cleared by their provider. Those with life-threatening conditions, sensory deficits affecting calls, upcoming surgeries or certain mental health conditions cannot join.

Inclusion Criteria

I have experienced pain on most days in the last six months.

I have a cell phone I can use freely and am willing to regularly text or call a peer partner.

The study is open to female veterans receiving care at the VA Connecticut Healthcare System or VA Central Western Massachusetts.

Exclusion Criteria

I am scheduled for or have recently had surgery.

You have a mental health condition that would make it hard for you to take part in treatment or be a good peer.

I do not have hearing or speaking issues that would prevent me from participating in phone calls.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (telephone-based)

Behavioral Run-in

Participants undergo a 1-week behavioral run-in period to mimic demands of the intervention

1 week

1 visit (telephone-based)

Treatment

Participants engage in an 8-week home-based reciprocal peer support pain self-management intervention

8 weeks

Weekly phone calls and nightly text messages

Follow-up

Participants are monitored for retention and effectiveness post-treatment

3 months

Assessments at 10 and 22 weeks post-intervention start

Long-term Follow-up

Long-term follow-up to assess retention and responder analysis

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Project CONNECT

Trial Overview Project CONNECT is being tested; it's an 8-week home-based program where paired participants support each other through text messages and weekly calls to manage chronic pain using coping skills, activity goals setting, and a walking program. All eligible women will receive this intervention without comparison groups.

How Is the Trial Designed?

Group I: Pilot Arm: Project CONNECT Experimental Treatment 1 Intervention

8-week home based reciprocal peer support pain self-management program for chronic musculoskeletal pain

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

VA Connecticut Healthcare System

Collaborator

Trials

86

Recruited

8,800+

Yale University

Collaborator

Trials

1,963

Recruited

3,046,000+

Published Research Related to This Trial

A pilot study involving 20 male veterans with chronic musculoskeletal pain tested a peer support intervention, where peer coaches guided patients in pain self-management strategies over 4 months.

While the primary outcome of pain improvement did not reach statistical significance, secondary outcomes like self-efficacy and pain centrality showed moderate improvements, suggesting that peer-delivered strategies may be beneficial for veterans managing chronic pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A brief peer support intervention for veterans with chronic musculoskeletal pain: a pilot study of feasibility and effectiveness. Matthias, MS., McGuire, AB., Kukla, M., et al.[2022]

Veterans participating in a peer support intervention for chronic pain found it beneficial to connect with fellow veterans and peer coaches who also experience chronic pain, which enhanced their engagement in the program.

However, logistical challenges and issues with motivation were significant barriers to participation, highlighting the need for strategies to address these obstacles in future interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain. Matthias, MS., Kukla, M., McGuire, AB., et al.[2019]

A qualitative study involving 18 patients with chronic musculoskeletal pain and depression identified key barriers to self-management, including lack of support, limited resources, and ineffective pain-relief strategies.

Facilitators for better self-management included encouragement from healthcare providers, improved depression treatment, and having a variety of self-management strategies to choose from.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression. Bair, MJ., Matthias, MS., Nyland, KA., et al.[2022]

A redesigned, shorter self-management education program for musculoskeletal conditions led to small but statistically significant improvements in pain, health distress, and self-efficacy among participants, based on a study with a 47% response rate (n=102).

The program, which incorporates motivational interviewing and adult learning principles, highlights the importance of community-based education in managing chronic musculoskeletal conditions effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Take Charge of Pain: evaluating a community-targeted self-management education program for people with musculoskeletal pain. Hoon, E., Smith, K., Black, J., et al.[2017]

A 7-week self-management program for chronic musculoskeletal pain was attended by 376 out of 528 recruited patients, showing a high uptake rate of 71% and an 82% completion rate among those who participated.

Participants experienced significant improvements in patient activation, health status, and reductions in depression, anxiety, and pain severity, indicating the program's efficacy in enhancing self-management skills for chronic pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of uptake and effect on patient-reported outcomes of a clinician and patient co-led chronic musculoskeletal pain self-management programme provided by the UK National Health Service. Anderson, JK., Wallace, LM.[2020]

A randomized controlled trial involving 215 veterans with chronic musculoskeletal pain tested a peer coach-delivered pain self-management program, but adherence to the program was low, with only 13% of patients attending the recommended number of meetings.

Both the peer support and control groups showed a decrease in total pain over 9 months, but there was no significant difference in pain reduction or other secondary outcomes between the two groups, suggesting that the peer support model may need to be revised for better effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial. Matthias, MS., Bair, MJ., Ofner, S., et al.[2021]

The peer support intervention (PALS) was found to be feasible and acceptable for older adults (ages 65-79) with Chronic Low Back Pain (CLBP), with two-thirds of participants retained throughout the study.

Participants expressed high satisfaction with PALS and indicated they would recommend it to others, suggesting that the intervention could be a valuable resource for self-management in CLBP, although recruitment methods need refinement for future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

PALS: peer support for community dwelling older people with chronic low back pain: a feasibility and acceptability study. Cooper, K., Schofield, P., Smith, BH., et al.[2021]

In a study involving 246 participants with chronic pain, the Manage My Pain (MMP) app was associated with lower anxiety levels and reduced pain catastrophizing, indicating its potential effectiveness in managing chronic pain alongside standard care.

Approximately 73.6% of participants agreed to use the app, and those who engaged with it reported significant improvements in mental health outcomes, suggesting that digital tools can enhance patient self-management in chronic pain treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

User Engagement and Clinical Impact of the Manage My Pain App in Patients With Chronic Pain: A Real-World, Multi-site Trial. Bhatia, A., Kara, J., Janmohamed, T., et al.[2021]

Self-management (SM) support for musculoskeletal pain (MSKP) is a promising but underutilized strategy that can help individuals manage their symptoms effectively and improve their quality of life, although past studies have shown mixed outcomes.

Recent positive results in SM for MSKP suggest that incorporating psychosocial skills and contemporary pain neuroscience into treatment can enhance engagement and effectiveness, highlighting the need for therapists to improve their communication and understanding of these approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physiotherapy support for self-management of persisting musculoskeletal pain disorders. Diener, I.[2022]

Self-management interventions for chronic musculoskeletal pain show that baseline factors like self-efficacy and depression significantly predict treatment outcomes, while pain catastrophizing and physical activity can mediate these outcomes.

Despite the good methodological quality of the studies reviewed, there is insufficient evidence on which baseline factors moderate the effectiveness of self-management treatments, indicating a need for future research with stronger designs and larger sample sizes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs. Miles, CL., Pincus, T., Carnes, D., et al.[2022]

Citations

1. England pubmed.ncbi.nlm.nih.gov

A brief peer support intervention for veterans with chronic musculoskeletal pain: a pilot study of feasibility and effectiveness. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain. [2019]

3. England pubmed.ncbi.nlm.nih.gov

Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression. [2022]

4. Australia pubmed.ncbi.nlm.nih.gov

Take Charge of Pain: evaluating a community-targeted self-management education program for people with musculoskeletal pain. [2017]

5. England pubmed.ncbi.nlm.nih.gov

Evaluation of uptake and effect on patient-reported outcomes of a clinician and patient co-led chronic musculoskeletal pain self-management programme provided by the UK National Health Service. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial. [2021]

7. England pubmed.ncbi.nlm.nih.gov

PALS: peer support for community dwelling older people with chronic low back pain: a feasibility and acceptability study. [2021]

8. Canada pubmed.ncbi.nlm.nih.gov

User Engagement and Clinical Impact of the Manage My Pain App in Patients With Chronic Pain: A Real-World, Multi-site Trial. [2021]

9. South Africa pubmed.ncbi.nlm.nih.gov

Physiotherapy support for self-management of persisting musculoskeletal pain disorders. [2022]

10. England pubmed.ncbi.nlm.nih.gov

Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs. [2022]