Impact
Comparing Two Ways to Help Patients Manage Long-Term Pain
Objective
To implement a randomized trial to compare two programs for managing chronic pain: (1) shared decision making and (2) cognitive behavioral therapy and motivational interviewing.
Approach
We monitored opioid dose, pain interference, and physical functioning of patients at three health systems in North Carolina and Tennessee.
Impact
This research can guide clinicians, researchers, and policymakers as they seek to mprove treatment of chronic pain.
Chronic Pain and Opioid Use
Long-term pain —or pain that lasts for months or years—is one of the most common health problems in the United States. About 20% of American adults suffer from long-term pain.
Clinicians often treat long-term pain with opioids. Opioids can help ease pain in the short term, but evidence is weak regarding their effectiveness in the long term. For some people, long-term opioid use can lead to addiction and overdose.
People in pain need effective options and different types of support to help improve their function and enjoy life as much as possible. Common strategies include medications and a range of non-pharmacologic options.
The INSPIRE Trial
What is the study about?
INtegrated Services for Pain: Interventions to Reduce Pain Effectively (INSPIRE) is a study that compared two programs for helping people living with long-term pain. To take part in the study, people needed to be taking opioid medications for three or more months. Cancer patients were excluded from the study.
What was the study design?
Researchers randomly assigned study participants to one of two study programs: (1) Shared Decision Making or (2) Cognitive Behavioral Therapy and Motivational Interviewing. Both programs adhered to clinical guidelines for opioid prescribing.
| Shared Decision Making (SDM) | Cognitive Behavioral Therapy (CBT) + Motivational Interviewing (MI) | |
|---|---|---|
| What is it? | Patient and clinician work together to make decisions that are best for the patient | Patient is taught strategies to better cope with chronic pain |
| What does this look like? | Patient has usual pain care visits with a clinician trained in SDM | Patient has usual pain care visits with their clinician; Patient has 8 weekly CBT group sessions with a therapist; Patient has 1 individual MI session |
| What happens during the visit? | Patient and clinician discuss patient’s values, concerns, and preferences for managing pain; Patient and clinician may discuss slowly reducing or stopping opioid use, if the patient chooses to do so | Therapist teaches patients coping skills to increase their ability to function and engage in regular activities; Patient learns how to change the response in the brain that makes pain worse |
| Tools used | Patient packet with decision aids and fact sheets; Treatment options | Patient packet with worksheets; At-home exercises |
What tools and resources were used?
Participants in the Shared Decision Making program got a packet with the following resources:
- “Car with Four Flat Tires” video from the American Chronic Pain Association (ACPA). It described how chronic pain may impact people’s lives.
- “Prescription Opioids: What You Need to Know” factsheet (PDF) from the Centers for Disease Control and Prevention (CDC) and the American Hospital Association. It gave some general information about opioid medication.
- “Taking Opioid Medicine for Chronic Pain: Talk to Your Doctor About What’s Right for You” Factsheet (PDF) from RTI International. It gave information patients can use when talking with their clinician about taking opioid medication.
- “Non-Opioid Options for Managing Chronic Pain” article from Harvard Health Publishing. It provided information about options, aside from opioid medication, to help with chronic pain.
- “Preparing for Your Health Care Visit” worksheet from ACPA (link no longer available). It provided information for patients to consider before meeting with their clinician.
Participants in the Cognitive Behavioral Therapy and Motivational Interviewing program got a packet with the following resources:
What was the role of the Advisory Panel?
Throughout the study, we partnered with an Advisory Committee that included patients who had lived experience with pain, advocacy organizations, clinicians, and pain experts. The Committee met with researchers regularly to provide feedback on study decisions, recruitment, and materials.
Who were the study participants?
This study was conducted in primary care and pain care clinics where patients were receiving their usual care at three health systems in North Carolina and Tennessee:
- Duke University Medical Center in Durham, NC
- University of North Carolina Health System in Chapel Hill, NC
- Vanderbilt University Medical Center in Nashville, TN
How were study data collected?
Researchers compared the two programs by looking at changes in opioid dose and physical functioning over time. They collected information on patients’ prescribed opioid dose from patient electronic health records at the beginning of the study and then again at six, twelve, and eighteen months. Participants completed surveys at the beginning of the study and at six and twelve months to answer questions about:
- Ability to do physical activities, such as running errands and household chores
- How pain interferes with daily life, such as ability to socialize
- Current pain level
- Anxiety and depression symptoms
- Satisfaction with pain care
What are the study’s next steps?
The recruitment phase of the study is complete and the research team is analyzing data. Results are forthcoming.
Where can patients learn more about long term pain?
• American Chronic Pain Association newsletter
We thank the INSPIRE study team collaborators for their contributions. We also thank everyone who enrolled in the study. Research reported here was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (OPD-1610-37006).
Disclaimers: The statements presented here are solely the responsibility of the authors and do not necessarily represent the views of PCORI. Reference to materials on the CDC website does not constitute its endorsement or recommendation by the U.S. Government, Department of Health and Human Services, or Centers for Disease Control and Prevention.
