UH3 Project: Collaborative Care for Chronic Pain in Primary Care (PPACT)

UH3 Project: Collaborative Care for Chronic Pain in Primary Care (PPACT)

Principal Investigator:

Sponsoring Institution: Kaiser Permanente Center for Health Research

Collaborators:

  • Kaiser Permanente regional health systems in Georgia, Northwest, and Hawaii
  • Oregon Health and Science University

NIH Institutes Providing Oversight: National Institute of Neurological Disorders and Stroke (NINDS) and National Institute on Drug Abuse (NIDA)

Program Official: Linda Porter, PhD (NINDS)

Project Scientist: Sarah Duffy, PhD (NIDA)

ClinicalTrials.gov Identifier: NCT02113592

Study Locations: Primary care clinics in 3 regional health systems 

Trial Status: Completed

Study Snapshot

Trial Summary

Study question and significance: Chronic pain is common, disabling, and costly. Few clinical trials have examined the use of cognitive behavioral therapy (CBT) interventions in primary care settings to improve chronic pain among patients who are receiving long-term opioid therapy.

Design and setting: Pragmatic, cluster randomized trial with 850 adult patients on long-term opioid therapy and receiving care in primary care clinics in 3 Kaiser Permanente healthcare regions from 2014 through 2016.

Intervention and methods: PPACT tested implementation of a CBT intervention that included pain self-management skills and yoga-based adapted movement in 12 weekly, 90-minute groups taught by an interdisciplinary team versus usual care. The primary outcome was self-reported pain as measured by the Pain, Enjoyment, General Activity (PEG) scale assessed quarterly over 12 months. Secondary outcomes included pain-related disability, satisfaction with care, and opioid and benzodiazepine use based as reflected in electronic health record data.

Findings: After 12 months, the intervention group experienced greater reductions on all self-reported outcomes. At 6 months, the intervention group reported higher satisfaction with primary care. Benzodiazepine use decreased more in the intervention group, but opioid use did not differ significantly between the study groups.

Conclusions and relevance: A collaborative care intervention for chronic pain consisting of primary care–based CBT using frontline clinicians resulted in modest but sustained reductions in measures of pain and pain-related disability compared with usual care but did not reduce the use of opioid medications.

NIH Project Information

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