Screening, Brief Intervention, and Referral to Treatment for Pain Management for Veterans Seeking Service-Connection Payments for Musculoskeletal Disorders: SBIRT-PM Study Protocol

Steve Martino, VA Connecticut Healthcare System, West Haven, Connecticut.
Christina Lazar, VA Connecticut Healthcare System, West Haven, Connecticut.
John Sellinger, VA Connecticut Healthcare System, West Haven, Connecticut.
Kathryn Gilstad-Hayden, Yale University, New Haven, Connecticut.
Brenda Fenton, VA Connecticut Healthcare System, West Haven, Connecticut.
Paul G. Barnett, Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, California.
Brad R. Brummett, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts.
Diana M. Higgins, VA Boston Healthcare System, Boston, Massachusetts.
Paul Holtzheimer, White River Junction VA Medical Center, White River Junction, Vermont.
Kristin Mattocks, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts.
Tu Ngo, Bedford VA Medical Center, Bedford, Massachusetts.
Thomas E. Reznik, Providence VA Medical Center, Providence, Rhode Island.
Alicia M. Semiatin, VA Manchester Medical Center, Manchester, New Hampshire.
Todd Stapley, VA Maine Medical Center, Togus, Maine, USA.
Marc I. Rosen, VA Connecticut Healthcare System, West Haven, Connecticut.

Abstract

BACKGROUND: Veterans with significant chronic pain from musculoskeletal disorders are at risk of substance misuse. Veterans whose condition is the result of military service may be eligible for a disability pension. Department of Veterans Affairs compensation examinations, which determine the degree of disability and whether it was connected to military service, represent an opportunity to engage Veterans in pain management and substance use treatments. A multisite randomized clinical trial is testing the effectiveness and cost-effectiveness of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) for Veterans seeking compensation for musculoskeletal disorders. This telephone-based intervention is delivered through a hub-and-spoke configuration. DESIGN: This study is a two-arm, parallel-group, 36-week, multisite randomized controlled single-blind trial. It will randomize 1,100 Veterans experiencing pain and seeking service-connection for musculoskeletal disorders to either SBIRT-PM or usual care across eight New England VA medical centers. The study balances pragmatic with explanatory methodological features. Primary outcomes are pain severity and number of substances misused. Nonpharmacological pain management and substance use services utilization are tracked in the trial. SUMMARY: Early trial enrollment targets were met across sites. SBIRT-PM could help Veterans, at the time of their compensation claims, use multimodal pain treatments and reduce existing substance misuse. Strategies to address COVID-19 pandemic impacts on the SBIRT-PM protocol have been developed to maintain its pragmatic and exploratory integrity.