Abstract
BackgroundLow back pain is a costly healthcare problem and the leading cause of disability among adults in the United States. Primary care providers urgently need effective ways to deliver evidence-based, nonpharmacological therapies for chronic low back pain. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain.ObjectiveThe Pain eHealth Platform (PEP) pilot trial aims to test the feasibility of a highly innovative intervention that (1) uses an electronic health record (EHR) query to systematically identify a phenotype of obese, older adults with chronic low back pain who may benefit from Web-based behavioral treatments; (2) delivers highly tailored messages to eligible older adults with chronic low back pain via the patient portal; (3) links affected patients to a Web app that provides education on the efficacy of evidence-based, nonpharmacological, behavioral pain treatments; and (4) directs patients to existing Web-based health treatment tools.MethodsUsing a three-step modified Delphi method, an expert panel of primary care providers will define a low back pain phenotype for an EHR query. Using the defined low back pain phenotype, an EHR query will be created to identify patients who may benefit from the PEP. Up to 15 patients with low back pain will be interviewed to refine the tailored messaging, esthetics, and content of the patient-facing Web app within the PEP. Up to 10 primary care providers will be interviewed to better understand the facilitators and barriers to implementing the PEP, given their clinic workflow. We will assess the feasibility of the PEP in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients. The primary outcome of the study is usability as measured by the System Usability Scale.ResultsQualitative interviews with primary care providers were completed in April 2019. Qualitative interviews with patients will begin in December 2019.ConclusionsThe PEP will leverage informatics and the patient portal to deliver evidence-based nonpharmacological treatment information to adults with chronic low back pain. Results from this study may help inform the development of Web-based health platforms for other pain and chronic health conditions.International Registered Report Identifier (IRRID)DERR1-10.2196/14525
Highlights
Low back pain is the leading cause of disability worldwide and its prevalence increases with age [1]
We will assess the feasibility of the Pain eHealth Platform (PEP) in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients
Qualitative interviews with primary care providers were completed in April 2019
Summary
Low back pain is the leading cause of disability worldwide and its prevalence increases with age [1]. An estimated 17,029 people (5.2 per 100,000 people) died from prescription opioid overdoses in 2017 [3] This is a pressing concern for older adults due to the increasing incidence of prescription opioid misuse among members of this group [4,5]. Older adults are significantly more likely to have chronic low back pain compared to their normal weight counterparts [6]. Obesity contributes to a higher frequency of intractable pain episodes [7], the use of stronger opioid medications compared to normal-weight adults with chronic pain [7], and increased pain severity [8]. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain
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