Care Management for the Effective Use of Opioids (CAMEO)
Low Back Pain, Pain
About this trial
This is an interventional treatment trial for Low Back Pain focused on measuring Back pain, Care Management, Pain, Patient outcomes, Patient-center Care, Primary care
Eligibility Criteria
Inclusion Criteria:
Veterans will be eligible if they have:
- chronic lower back pain of at least moderate intensity
- pain for 6 months
- on chronic opioid therapy
- and access to a working telephone
Exclusion Criteria:
Exclusion criteria includes:
- severe medical conditions
- active psychosis
- schizophrenia
- active suicidal ideation
- pending back surgery
- moderately severe cognitive impairment
- involvement in ongoing pain trials
- and pregnant or trying to become pregnant
The investigators will exclude Veterans with an active substance use disorder (i.e., those currently in treatment), but to maximize generalizability the investigators will not exclude those with a past history of substance abuse.
Sites / Locations
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Arm 1: Pharmacological (MED)
Arm 2: Behavioral treatment (CBT)
Subjects in the Pharmacological (MED) arm will receive at least 8 contacts with the nurse care managers (NCM) over the trial period. Participants will have an initial visit at baseline to assess their current and past treatments for chronic lower back pain, pain intensity, and pain-related limitations. Patients' opioids will be adjusted and/or co-analgesics (or adjuvants) will be initiated. During follow-up calls, patients' pain severity, response to treatment, adherence, adverse effects, and desire to change current treatment will be assessed. Follow-up NCM telephone contacts will occur at 2 and 4 weeks after baseline, and months 2, 3, 4, 6, and 9 months. On average, these calls last between 10 to 20 minutes. Detailed logs will be kept of the timing and content of patient contacts.
Veterans randomized to behavioral treatment arm (CBT) will receive a series of 8 pain self-management/coping skills training sessions delivered by one of three primary-care based clinical psychologists. Since optimal application of non-pharmacological interventions for pain involves tailoring to patient needs, participants will be introduced to a menu of self-management and coping skills rather than receive a prescribed program. Delivery of the behavioral intervention will employ a flexible approach that is easily adapted to individual preferences and perceived need for learning specific pain coping skills. Tailoring will include the selection of relevant content and skills and assessment of readiness to change behaviors.