Enhanced Navigation to Improve Pain-related Psychological Support and Resource Use in Orthopedics

About This Grant

ABSTRACT Musculoskeletal pain, particularly high impact chronic pain (HICP), is a major public health issue affecting millions. Chronic musculoskeletal pain is often associated with high psychological distress, and while psychological interventions can improve outcomes, psychological distress is frequently neglected in current pain care. Orthopedic settings, where patients commonly present with HICP, offer a promising yet underutilized opportunity to introduce access to effective pain-related psychological resources. However, orthopedic clinicians often lack training in psychological assessment, feel uncomfortable discussing mental health, and face time constraints, which limits patient exposure to psychological resources. To address these challenges, we will test the feasibility and acceptability of a novel Psychological Support and Resource Navigator program. This program helps orthopedic clincians identify patients with high pain-related psychological distress and connect them to evidence-supported psychological resources for pain. An automated alert in the electronic health record will notify clinicians of eligible patients. The navigator will then engage patients through phone, video, or in-person visits to deliver three core components: education, skills training, and facilitation. The navigator will first provide pain psychoeducation to help participants understand the relationship between psychological distress and pain. Second, the navigator will offer a brief intervention, such as relaxation training, to help patients with daily pain self-management. Third, the navigator will review a menu of evidence- supported psychological resources for pain, including free online tools like painTRAINER, psychologically informed physical therapy, and counseling. The navigator will help patients choose options that match their needs and guide them through access and scheduling. Follow-up calls at six and twelve weeks will track progress, reinforce use, and troubleshoot barriers. We will evaluate the feasibility and acceptability of the navigator program in a two-arm trial involving 63 patients with high psychological distress in the Duke Department of Orthopaedic Surgery randomized (2:1) to receive either the navigator program or a brochure with information about psychological resources. We will use a mixed methods approach to assess a variety of primary and secondary outcomes. Benchmarks for feasibility include achieving high rates of (1) enrollment among eligible patients, (2) call completion, (3) fidelity to the navigator program, and (4) psychological resource use by the 12-week follow-up. Acceptability will be measured by participant satisfaction with the program. This study represents a novel approach to integrating evidence-supported psychological care into orthopedic settings, aiming to improve pain-related outcomes. Findings from this study will directly inform the execution of a future pragmatic comparative effectiveness trial of the program, contributing to the broader goal of enhancing the clinical integration of evidence-supported interventions for pain and psychological distress.