IMproving Pain Using Peer RE-inforced Self-management Skills

Peer training will consist of 2 core components: 1) How to deliver the pain self-management
curriculum; and 2) Peer-support competencies (i.e., "how to be a peer"). After initial
training, research personnel will remain in regular contact with peers to answer questions,
troubleshoot problems, and facilitate mutual support among peers. Peers will meet as a
group with the psychologist for bi-weekly peer supervision either in-person or via
teleconference.

The self-management program will be delivered in two phases. Phase 1 will be a 2-hour
didactic session led by the study nurse and will parallel the content described for the
peers. The pain self-management manual developed for our earlier studies will be used and
distributed to the patients. Phase 2 will be additional sessions delivered by peers, over a
4-month period. At the end of the Phase 1 session, the peers will meet their assigned
patients. Peers will be assigned 2 patients, and pairings will be made with input from the
study nurse and psychologist, with patients and peers being age- and gender-matched to the
extent possible.

After their initial face-to-face meeting, peers will be asked to keep in regular contact
with patients over a 4-month period. Specifically, peers will contact patients a minimum of
bi-weekly via telephone or in-person.

Peers will be asked to review each of the topic areas covered in the self-management manual.
Peers will review a different topic each session, ask if the patient has questions, and
discuss his or her personal experience with the topic being covered during that session.
Modeling what the nurse care manager has done in prior studies, peers will work with
patients to help them to set goals and to evaluate whether these goals are realistic. A new
goal will be set at each session, with the peer following up on the previous goals with the
patient, whether they were accomplished, and if not, possible courses of action (e.g.,
modifying the goal or offering other advice to accomplish the goal). Throughout these
sessions peers will be encouraged to draw on their own experiences and how they personally
overcame obstacles and handled setbacks and frustrations. Peers will not advise on or
discuss medications or medical questions with patients. If such questions come up, peers
will instruct patients to contact their PCPs.

Inclusion Criteria:

- Peers will be eligible if they have chronic musculoskeletal pain and have completed a
pain self-management program from any of these chronic pain trials:

- Stepped Care for Depression and Musculoskeletal Pain (SCAMP)

- Evaluation of Stepped Care for Chronic Pain in Iraq and Afghanistan Veterans
(ESCAPE)

- CAre Management for the Effective use of Opioids (CAMEO)

- Or participants of the VA Pain School or VA Pain program

- Peers may also be recommended by their primary care providers at the VA

- Eligible patients must have musculoskeletal pain in the low back, cervical spine, or
extremities (hip, knee, or shoulder) that has persisted for 3 months

- And have pain of at least moderate intensity as defined by a Brief Pain Inventory
score 5

Exclusion Criteria:

- Patients will be excluded if they have active suicidal ideation

- Have been hospitalized for psychiatric or substance abuse reasons in the last 6
months pending back surgery

- Current substance dependence

- Severe medical conditions (e.g., New York Heart Association Class III or IV heart
failure) that precludes participation

- Or severe hearing or speech impairment