Abstract
BackgroundThe prevalence of chronic pain conditions is growing. Low back pain was the primary cause of disability worldwide out of 156 conditions assessed between 1990 and 2016, according to the Global Burden of Disease Study. Conventional medical approaches have failed to identify effective and long-lasting approaches for the management of chronic pain, and often fail to consider the multiple domains that influence overall health and can contribute to the pain experience. Leading international organizations that focus on pain research have stated the importance of considering these other domains within holistic and multidisciplinary frameworks for treating pain. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice.MethodsThe purpose of this manuscript is to describe an implementation protocol that is being used to deliver a complex holistic health intervention at multiple sites within a large government health system, as part of a larger multisite trial for patients with chronic low back pain. The Move to Health program developed by the US Army Medical Command was tailored for specific application to patients with low back pain and begins by providing an empirical link between eight different health domains (that include physical, emotional, social, and psychological constructs) and chronic low back pain. Through a six-step process, a health coach leverages motivational interviewing and information from a personal health inventory to guide the patient through a series of conversations about behavioral lifestyle choices. The patient chooses which domains they want to prioritize, and the health coach helps implement the plan with the use of SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goals and a series of resources for every domain, triaged from self-management to specialist referral.DiscussionComplex interventions described in clinical trials are often challenging to implement because they lack sufficient details. Implementation protocols can improve the ability to properly deliver trial interventions into regular clinical practice with increased fidelity.Trial registrationImplementation of this intervention protocol was developed for a clinical trial that was registered a priori (clinicaltrials.gov #NCT04172038).
Highlights
Chronic low back pain in the military health system Chronic pain is a ubiquitous and growing concern in the Military Health System (MHS) as it is in civilian health systems
The most common chronic pain condition seen in the MHS is low back pain [2, 3], accounting for about 70% of medical encounters for chronic pain in active duty military members [1]
The purpose of this paper is to describe the development of the M2H program as a strategy to promote the biopsychosocial management of individuals with chronic Low back pain (LBP)
Summary
Chronic low back pain in the military health system Chronic pain is a ubiquitous and growing concern in the Military Health System (MHS) as it is in civilian health systems. Incident rates of chronic pain for active-duty military members have increased more than threefold in recent years [1]. The most common chronic pain condition seen in the MHS is low back pain [2, 3], accounting for about 70% of medical encounters for chronic pain in active duty military members [1]. Low back pain (LBP) has been the most common reason for a medical encounter in the MHS every year since 2011, accounting for over 1 million encounters in 2015 [4]. In the MHS, LBP is the most common diagnosis for which opioids are prescribed [5] and the leading cause of medical discharge across all military services [6]. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice
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