UH3 Project: Collaborative Care for Chronic Pain in Primary Care (PPACT)
Overview
Principal Investigator:
Sponsoring Institution: Kaiser Permanente Center for Health Research
Collaborators:
-
Kaiser Permanente regional health systems in Georgia, Northwest, and Hawaii
-
Oregon Health and Science University
NIH Institutes Providing Oversight: National Institute of Neurological Disorders and Stroke (NINDS) and National Institute on Drug Abuse (NIDA)
Program Official: Linda Porter, PhD (NINDS)
Project Scientist: Sarah Duffy, PhD (NIDA)
ClinicalTrials.gov Identifier: NCT02113592
Study Locations: Primary care clinics in 3 regional health systems
Trial Status: Completed
Trial Summary
Study question and significance: Chronic pain is common, disabling, and costly. Few clinical trials have examined the use of cognitive behavioral therapy (CBT) interventions in primary care settings to improve chronic pain among patients who are receiving long-term opioid therapy.
Design and setting: Pragmatic, cluster randomized trial with 850 adult patients on long-term opioid therapy and receiving care in primary care clinics in 3 Kaiser Permanente healthcare regions from 2014 through 2016.
Intervention and methods: PPACT tested implementation of a CBT intervention that included pain self-management skills and yoga-based adapted movement in 12 weekly, 90-minute groups taught by an interdisciplinary team versus usual care. The primary outcome was self-reported pain as measured by the Pain, Enjoyment, General Activity (PEG) scale assessed quarterly over 12 months. Secondary outcomes included pain-related disability, satisfaction with care, and opioid and benzodiazepine use based as reflected in electronic health record data.
Findings: After 12 months, the intervention group experienced greater reductions on all self-reported outcomes. At 6 months, the intervention group reported higher satisfaction with primary care. Benzodiazepine use decreased more in the intervention group, but opioid use did not differ significantly between the study groups.
Conclusions and relevance: A collaborative care intervention for chronic pain consisting of primary care–based CBT using frontline clinicians resulted in modest but sustained reductions in measures of pain and pain-related disability compared with usual care but did not reduce the use of opioid medications.
Data and Resource Sharing
- PPACT Public Use Data Sets
PPACT Public Use Data Sets
- PPACT Data Dictionary
PPACT Data Dictionary
- PPACT Protocol
PPACT Protocol
- PPACT_Recruitment Letter
PPACT Recruitment Letter
- PPACT_DeBar_UH3 follow-up
PPACT ethics and regulatory documentation - UH3 project updates
- LynnDeBar-CollaborativeCareChronicPainPrimaryCare-PPACT
Minutes from Ethics/Regulatory Call with Dr. DeBar’s Trial – PPACT
Featured Interviews
Drs. McMullen, DeBar, and Elder discuss lessons learned in the Collaboratory’s PPACT pragmatic trial.
News and Interviews
- News_Your Pragmatic Trial Has Ended Now What
January 22, 2024: Your Pragmatic Trial Has Ended. Now What?
- News_Wealth of New Insights From the NIH Pragmatic Trials Collaboratory
December 13, 2022: In Our Tenth Year, a Wealth of New Insights From the NIH Pragmatic Trials Collaboratory
- News_A Year of New Insights From the NIH Collaboratory
December 14, 2021: A Year of New Insights From the NIH Collaboratory
- News_PPACT
November 9, 2021: PPACT Study Finds Benefits of Cognitive Behavioral Therapy in Reducing Chronic Pain and Pain-Related Disability
- News_A Year of Results and New Insights From the NIH Collaboratory
December 15, 2020: A Year of Results and New Insights From the NIH Collaboratory
- News_Online NIH Course on Pragmatic and Group-Randomized Trials
January 24, 2017: New Online NIH Course on Pragmatic and Group-Randomized Trials
- News_Applying PRECIS Ratings to Collaboratory Pragmatic Trials
January 16, 2016: Applying PRECIS Ratings to Collaboratory Pragmatic Trials
- News_Collaboratory PIs Give Advice to New Pragmatic Trials
November 1, 2019: Collaboratory PIs Give Advice to New Pragmatic Trials
- News_PIs of Completed NIH Collaboratory Demonstration Projects Share Accomplishments
July 14, 2020: PIs of Completed NIH Collaboratory Trials Share Accomplishments
- News_ EHR Workshop Grand Rounds Series Continues With Experiences From the Collaboratory PCTs
May 27, 2020: EHR Workshop Grand Rounds Series Continues With Experiences From the Collaboratory PCTs
Publications
- Benes et al Pain Manag Nurs 2022
Treating persistent pain: a nurse co-led, interdisciplinary model for primary care
- Smith et al Med Care 2022
Economic evaluation: a randomized pragmatic trial of a primary care-based cognitive behavioral intervention for adults receiving long-term opioids for chronic pain
- PPACT Study Snapshot
PPACT Study Snapshot
- Von Korff M et al Pain 2020
Graded chronic pain scale revised: mild, bothersome, and high-impact chronic pain
- DeBar et al Ann Intern Med 2021
PPACT Main Outcome Paper
- Edmond and Keefe Pain 2015
Validating pain communication: current state of the science
- Richesson et al J Am Med Inform Assoc 2021
Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory
- Von Korff et al Pain Med 2020
Identifying multisite chronic pain with electronic health records data
- Living Textbook Chapter_Which PCTs Should Have a DMC
Living Textbook Chapter: Which PCTs Should Have a DMC?
- Living Textbook_How Are PRO Measures Used
Living Textbook: How are PRO Measures Used?
- Living Textbook_The Embedded Pragmatic Trials Ecosystem
Living Textbook: The Embedded Pragmatic Clinical Trial Ecosystem
- Living Textbook_Choosing PRO Measures
Living Textbook: Choosing PRO Measures
- Living Textbook_Incorporating PRO Data into the Electronic Health Record (EHR)
Living Textbook: Incorporating PRO Data into the Electronic Health Record (EHR)
- Mayhew et al Contemp Clin Trials Commun 2020
Interactive group-based orientation sessions: a method to improve adherence and retention in pragmatic clinical trials
- Gruß et al Int J Drug Policy 2019
Taking opioids in times of crisis: institutional oversight, chronic pain and suffering in an integrated healthcare delivery system in the U.S.
- Mayhew et al J Pain 2019
Development and assessment of a crosswalk between ICD-9-CM and ICD-10-CM to identify patients with common pain conditions
- Gruß et al J Gen Intern Med 2019
Satisfaction with primary care providers and health care services among patients with chronic pain: a mixed-methods study
- Living Textbook Chapter_Data Sharing Concerns
Living Textbook: Data Sharing Concerns
- Living Textbook Chapter_Data Sharing and Embedded Research
Living Textbook Chapter: Data Sharing Solutions for Embedded Research
- Owen-Smith et al J Gen Intern Med 2018
Automating collection of pain-related patient-reported outcomes to enhance clinical care and research
- Debar et al Contemp Clin Trials 2018
PPACT Study Design Paper
- PPACT 2017-Snapshot
PPACT Study Snapshot
- Living Textbook Chapter_Assessing Outcomes
Living Textbook Chapter: Using EHR Data_Assessing Outcomes
- Living Textbook Chapter_Assessing Feasibility
Living Textbook Chapter: Assessing Feasibility: Spotlight of Four NIH Collaboratory Trials
- Living Textbook Chapter_Dissemination and Implementation
Living Textbook Chapter: Dissemination and Implementation: Intervention Staffing and Training Flexibility
- Living Textbook_Alternative Approaches to Disclosure and Authorization
Living Textbook Chapter: Alternative Approaches to Disclosure and Authorization
- Living Textbook_Analysis Plan_Unanticipated Changes
Living Textbook Chapter: Analysis Plan: Unanticipated Changes
- Debar et al Trans Behav Med 2012
A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework
Presentations
- 2023 AcademyHealth Workshop_Day 1_O'Brien_Measuring Outcomes
Measuring Outcomes
- 2023 AcademyHealth Workshop_Day 1_Bosworth
Objectives and Trial Design: An Overview of Hybrid Designs
- 2023 NIH Workshop_Panel 1_DeBar_Glassenberg
2023 NIH Workshop Panel 1: DeBar, Glassenberg
- SC-Mtg-2023-Day2-DeBar
Lynn DeBar Sharing Study Results Presentation 2023 Steering Committee Meeting
- SC-Mtg-2023-Day1-DeBar
Lynn DeBar Presentation 2023 Steering Committee Meeting
- GR-Video-12-03-21
Primary Care-Based Behavioral Treatment for Long Term Opioid Users with Chronic Pain: Primary Results and Lessons Learned from the PPACT Pragmatic Trial (GR Video 2021)
- GR-Slides-12-03-21
Primary Care-Based Behavioral Treatment for Long Term Opioid Users with Chronic Pain: Primary Results and Lessons Learned from the PPACT Pragmatic Trial (GR Slides 2021)
- GR-Video-05-29-20
EHR Core Workshop: Experiences from the Collaboratory PCTs (GR Video 2020)
- GR-Slides-05-29-20
EHR Core Workshop: Experiences from the Collaboratory PCTs (GR Slides 2020)
- DeBar_Collaboratory_SC_23APR20
Lessons Learned about Embedding Complex Pragmatic Trials in Delivery Systems: Collaborative Care for Chronic Pain
- Presentations at the April 2020 SC Meeting
Presentations at the April 2020 SC Meeting
- Presentation_PPPACT_ARM_2018_c
Lessons Learned about Embedding and Sustaining Complex Pragmatic Trials in Delivery Systems: Collaborative Care for Chronic Pain (ARM 2018)
- SC-2019-Completed-PPACT
Collaborative Care for Chronic Pain in Primary Care (PPACT)
- Workshop Design and Analysis of PCT_Panel 2_To Cluster or Not to Cluster
Workshop Design and Analysis of PCT: Panel 2 - To Cluster or Not to Cluster
- 8.-DeBar_PPACT_Barriers-Lessons-Learned_FINAL
Lessons Learned about Embedding Complex Pragmatic Trials in Delivery Systems: Collaborative Care for Chronic Pain
- Panel-2_Health-System-Engagement_Dissemination-Workshop_24MAY2017
A vs B Workshop Panel 2: Health System Engagement: Partnership, Relationships and Transparency
- Dissemination and Implementation Workshop Panel 2_HCS Engagement
Dissemination and Implementation Workshop Panel 2: Health System Engagement: Partnership, Relationships, and Transparency
- DeBar-SC-May-2017
Collaborative Care for Chronic Pain in Primary Care: Overcoming Patient, Provider, Data, and System Challenges in Implementing the Pragmatic Trial
- GR-Video-10-14-16
Multi-disciplinary Chronic Pain Management in Primary Care: Paradox or Paradigm? (GR Video 2016)
- GR-Slides-10-14-16
Multi-disciplinary chronic pain management in primary care: paradox or paradigm? (GR Slides 2016)
- DeBar May 2016 Scorecard PPACT Collaboratory Steering Committee mtg
PPACT: Generalizable Lessons Learned Presentation at Steering Committee Meeting
- Debar_May 2016 Data Sharing PPACT Collaboratory Steering Meeting
PPACT: Data Governance and Data Sharing Presentation at Steering Committee Meeting
- PPACT_DeBar_04-21-15
Update on PPACT
- GR-Video-11-21-14
Successes Evolving from Constraints: Lessons Learned about Embedding Complex Pragmatic Trials in Delivery Systems (GR Video 2014)
- GR Slides 11-21-14
Successes Evolving From Constraints: Lessons Learned about Embedding Complex Pragmatic Trials in Delivery Systems-- Collaborative Care for Chronic Pain (GR Slides 2014)
- PPACT Steering Mtg_82014
Lessons Learned about Embedding Complex Pragmatic Trials in Delivery Systems: Collaborative Care for Chronic Pain
- PPACT Data Sharing_Debar_2-24-2014
Collaborative Care for Chronic Pain in Primary Care (PPACT)
- GR-Video-1-18-13
Collaborative Care for Chronic Pain in Primary Care (GR Video 2013)
- GR Slides 01-18-13
Collaborative Care for Chronic Pain in Primary Care (GR Slides 2013)