Improving the Management of Chronic Pain in Primary Care
Condition: Chronic Pain
MeSH terms: Chronic Pain
Study type: Interventional

Summary: 
      There are an estimated 100 million Americans with chronic pain. The enormity of the problem
      at the societal level is staggering, not simply in terms of its sheer prevalence but also the
      societal costs, including health care expenditures, disability compensation, lost
      productivity, and lost employment potential. The pharmacological focus in treatment tends to
      give patients with chronic pain a negative stereotype as many are viewed as drug seeking, or
      worse, they are perceived to have an imaginary illness. It is argued that these stigmas not
      only negatively affect the patients' healthcare experience, but also perpetuate maladaptive
      coping. In addition, it is suggested that reliance on pharmacological approaches have
      contributed to the rate of overdoses from prescribed opioids. In order to address this burden
      facing society, patients need opportunities to foster a sense of self-efficacy to manage
      their pain, as well as improve their healthcare experience by allowing them to dialogue with
      their clinician openly and freely about their chronic pain, and coping strategies.

      This study is designed to explore the impact of an intervention using photo-elicitation
      (based on Photovoice) and online group support (via Facebook) on participants' overall
      experience of chronic pain and patient-identified areas of function. Photovoice participants
      will utilize cameras that enable them to record issues related to their experiences, and
      subsequently display them. This method serves as an empowering tool to connect participants
      to key stakeholders in the community, facilitates change and opportunities that otherwise
      would not be available to marginalized groups.
    

Detailed description: 
      This is a multi-site study occurring between the University of Missouri, and the American
      Academy of Family Physicians National Research Network (NRN). The University of Missouri will
      be responsible for the following:

        -  Coordinating the approval of initial protocol as well as subsequent amendments.

        -  Ensure that each site is using the correct version of the protocol.

        -  Serve as the study contact.

        -  Participate in the selection of qualified sites for participation (the NRN will be
           responsible for recruitment and randomization. This process will be overseen by MU).

        -  Monitor progress and oversee all conduct of the study at participating sites.

        -  Responsible for the data analysis, reporting, integrity, and accuracy of data.

      There will be one protocol document, and each site will utilize this document. The lead site
      (MU) will develop the informed consent, which includes language that data will be shared with
      the NRN.

      The NRN will be the Institutional Review Board (IRB) of record for the 18 practices recruited
      to participate within the NRN, and will provide a letter of authorization and final IRB
      approval to the lead PI (MU).

      The study will test if a photo elicitation intervention combined with access to online
      community support and a chronic pain guideline can improve a 3-item measure of chronic pain
      [the PEG score: Pain intensity (P), Enjoyment of Life (E), and General Activity (G)] and a
      patient-identified area of function, compared to a group who receive the guideline alone.
    

Intervention name(s): Photo-elicitation and online group support
Intervention type(s): Behavioral
Intervention description(s): See above information.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment