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Grant Abstract: Implementation of a Pragmatic Trial of Whole Health Team vs. Primary Care Group Education to Promote Non-Pharmacological Strategies to Improve Pain, Function and Quality of Life in Veterans

Grant Number: 4UH3AT009765-03
PI Name: Seal
Project Title: Implementation of a Pragmatic Trial of Whole Health Team vs. Primary Care Group Education to Promote Non-Pharmacological Strategies to Improve Pain, Function and Quality of Life in Veterans

Abstract: In the wake of the opioid crisis, there is widespread use of complementary and integrative health modalities to manage chronic pain in veterans, including the use of dietary supplements, yet we lack current tools to collect information on the use of dietary supplements for pain in veterans in a feasible and comprehensive way. Thus, a knowledge gap exists regarding the prevalence and correlates of dietary supplement use in veterans, particularly in high-risk groups of veterans, such as those with moderate to severe chronic pain. This supplement entitled “Development of a Dietary Supplement Survey for a National Sample of Veterans with Chronic Pain” is in response to PA-18-817: Administrative Supplements for Research on Dietary Supplements. We propose to conduct the supplement on the platform of a parent award funded by the National Center for Complementary and Integrative Health to conduct a pragmatic randomized controlled trial comparing two active non-pharmacological approaches to chronic pain management in veterans enrolled in VA healthcare. Aim 1 of the supplement is to refine a draft of a Dietary Supplement (DS) Survey that inventories and describes dietary supplement use in veterans (and other populations) with chronic pain. To refine the draft DS survey, we propose to first assess face validity of the draft survey, including comprehensiveness, interpretability, acceptability and feasibility of administration by convening a subject matter expert panel and conducting veteran focus groups. Based on this stakeholder input, we will iteratively revise the draft DS survey. Next, we will obtain mixed methods end-user feedback on the DS survey from veteran participants enrolled in the wHOPE parent trial who have completed the revised DS survey. Aim 2 of the supplement is to collect and analyze data from at least 50 veterans enrolled in the parent wHOPE study who complete the draft DS survey. Quantitative survey data will be enriched with follow-up qualitative semi-structured interviews with a subsample of 10-20 veterans. Thus, we will be able to describe the prevalence of veterans using any dietary supplements, specific supplements used for pain and other reasons, and frequency and duration of use. In addition, using mixed methods, we will elaborate on veterans’ reasons for using dietary supplements, including substitution for pain medications, perceived benefits and harms, barriers to use (e.g., knowledge gaps, access), and disclosure to providers. Thus, mixed methods data collected through this supplement will not only be used to refine survey items, but will also enrich our understanding of the ways in which veterans use dietary supplements for chronic pain and wellness. Moreover, this one-year supplement, conducted on the platform of our NCCIH- funded wHOPE trial, will facilitate the development of a Dietary Supplement survey that can be rapidly deployed in a larger sample of wHOPE participants in subsequent trial years as well as have potential applicability to other populations with chronic pain.

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