Abstract
Rates of chronic pain and daily opioid use are higher among veterans relative to civilian populations. Increasing physical activity can reduce pain severity and decrease opioid use among patients with chronic pain. Behavioral economic strategies can improve physical activity levels but have been undertested in veterans with chronic pain. The objective of this study was to evaluate if a financial incentive combined with a loss aversion component—a “regret lottery” in which veterans could win money if they met a set goal or told how much they could have won had they met their goal—would increase physical activity levels among veterans with chronic pain. A 12-week single-blinded randomized controlled trial (ClinicalTrials.gov: NCT04013529) was designed. Veterans with chronic pain (N = 40) receiving care at a specialty pain clinic were eligible for participation, and were randomly assigned (1:1) to either (a) activity trackers and daily text message reminders to increase physical activity (“control arm”), or (b) the same plus a weekly regret lottery (“intervention arm”). For those in the intervention arm, participants who met their activity goal, had a chance to win a small ($30) or large ($100) gift card incentive; those who did not meet their goals were informed of what they would have won had they met their goal. The primary outcome, physical activity, was measured using self-reported physical activity and step counts using activity trackers. Secondary outcomes included changes in physical function, chronic pain severity, depression and opioid use. The sample was primarily white, male and disabled, with an average age of 57 years. No between-arm differences were noted for physical activity, physical function, chronic pain severity, depression or opioid use. Regret lottery-based approaches may be ineffective at increasing physical activity levels in veterans with chronic pain.Trial Registry: NCT04013529.
Highlights
Chronic pain, defined as pain that persists or recurs for more than 3 months [1], is a highly prevalent and costly condition in the United States
Opioids are less effective in treating chronic pain compared with non-opioid approaches [12, 13], and current Centers for Disease Control and Veterans Affairs (VA)/Department of Defense (DOD) guidelines recommend non-opioid approaches for treating patients with chronic pain, and tapering patients on opioids to lower, safer doses or to none at all [14,15,16]
The results outlined below address the primary objective of this study which was to determine if a weekly regret lottery could improve physical activity among veterans with chronic primary pain
Summary
Chronic pain, defined as pain that persists or recurs for more than 3 months [1], is a highly prevalent and costly condition in the United States. Rates of regular opioid analgesic use among veterans are high [8], putting them at increased risk for overdose, abuse and diversion [9,10,11]. Increasing physical activity has been shown to improve pain and decrease medication use among patients with chronic pain [17,18,19,20,21]. A recent meta-analysis of Cochrane Reviews found exercise and physical activity improved pain severity, physical function, and quality of life for patients with chronic pain [22]. Increasing physical activity in veterans can be challenging due to high rates of impeding medical and psychiatric comorbidities (e.g., heart disease, obesity, depression) [23,24,25,26,27]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
