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An Analysis of the Role of Mental Health in a Randomized Trial of a Walking Intervention for Black Veterans With Chronic Pain

  • Patrick J. Hammett
    Correspondence
    Address reprint requests to Patrick Hammett, PhD, MA, Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN.
    Affiliations
    Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota

    Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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  • Johanne Eliacin
    Affiliations
    Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana

    Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana

    Health Services Research, Regenstrief Institute, Indianapolis, Indiana
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  • Una E. Makris
    Affiliations
    Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, Dallas, Texas

    Department of Population and Data Sciences, UTSW, Dallas, Texas

    Department of Medicine, VA North Texas Health Care System, Dallas, Texas

    Department of Internal Medicine, Division of Rheumatic Diseases, VA North Texas Health Care System, Dallas, Texas
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  • Kelli D. Allen
    Affiliations
    Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Durham, North Carolina

    Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Robert D. Kerns
    Affiliations
    Departments of Psychiatry, Yale School of Medicine, New Haven, Connecticut

    Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center of Innovation, VA Connecticut Health Care System, West Haven, Connecticut
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  • Alicia Heapy
    Affiliations
    Departments of Psychiatry, Yale School of Medicine, New Haven, Connecticut

    Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center of Innovation, VA Connecticut Health Care System, West Haven, Connecticut
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  • Elizabeth S. Goldsmith
    Affiliations
    Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota

    Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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  • Laura A. Meis
    Affiliations
    Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota

    Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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  • Brent C. Taylor
    Affiliations
    Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota

    Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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  • Michael Saenger
    Affiliations
    Atlanta Veterans Affairs Health Care System, Atlanta, Georgia

    Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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  • Lee J.S. Cross
    Affiliations
    Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
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  • Tam Do
    Affiliations
    Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
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  • Mariah Branson
    Affiliations
    Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
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  • Diana J. Burgess
    Affiliations
    Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota

    Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Published:September 22, 2022DOI:https://doi.org/10.1016/j.jpain.2022.07.002

      Highlights

      • Randomized trial of a walking intervention for Black Veterans with chronic pain.
      • Veterans with a mental health disorder (MHDX) were more engaged than other patients.
      • Veterans with a MHDX saw reductions in pain intensity/interference at 3-months.
      • Veterans without a MHDX saw reductions in pain-related disability at 6-months.
      • More targeted, intensive care is needed for Black patients with chronic pain.

      Abstract

      Black patients and those with co-occurring mental health disorders are disproportionately affected by chronic pain, but few interventions target these populations. This is a secondary analysis of a randomized trial of a walking-focused proactive counseling intervention for Black Veterans with chronic musculoskeletal pain (ACTION). The primary aim was to examine intervention effectiveness among Veterans with an electronic health record-documented mental health diagnosis [depressive disorder, anxiety disorder, substance use disorder, post-traumatic stress disorder or serious mental illness (n = 205)] and those without a diagnosis (n = 175). About 380 Black Veterans receiving care at the Atlanta VA Health Care System were enrolled from 2016 to 2019 and randomized to the intervention or usual care (UC) (1:1). The intervention featured 6 telephone coaching sessions over 8–14 weeks to encourage walking. Participants with a mental health disorder were more likely to complete all counseling sessions (56% vs 38%) and reported improvements in global perceptions of pain and pain intensity/interference (secondary outcomes) at 3-months vs UC. Among participants without a mental health disorder, the intervention was associated with an improvement in pain-related disability at 6-months (primary outcome). Black chronic pain patients with co-occurring mental health disorders may require more intensive treatment to affect improvement in pain-related disability.

      Perspective

      This study examines the effectiveness of a walking intervention for chronic pain among Black Veterans with a mental health disorder. These patients were more engaged with the intervention than those without a mental health disorder. However, they did not experience reductions in pain-related disability, suggesting more intensive treatment is needed.

      Key words

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