Background and purpose: Opioid painkiller diversion from those with legitimate prescriptions and the overprescribing of opioids contribute to high levels of nonmedical use and are related to illicit opioid use. This project takes an innovative approach in addressing the underlying issues of this widespread public health issue. The project increases access to non-drug opioid alternatives for rural residents suffering from chronic pain and broad community education efforts will increase awareness of risks associated with opioid use prior to prescription receipt. This project fills an access gap between the adoption of recommendations of non-drug approaches and the extremely limited or nonexistent availability of such programs and services in rural areas. It does so by leveraging the reach of County Extension Agents (CEA) and a network of trained master health volunteers to offer Chronic Pain Self-Management (CPSMP) and a multi-component exercise program (Move with Ease) in rural areas.
Theoretical Framework: The proposed project engages multiple levels of the social-ecological model (SEM). Intrapersonal and interpersonal SEM levels are addressed through self-management programs, which provide social support for pain management. Self-management approaches are based on self-efficacy theory constructs. Community-based exercise class format is rooted in social cognitive theory, from which self-efficacy theory was derived. The referral strategies are based on research outcomes indicating those persons in the Contemplation stage, as measured by the Pain Stages of Change questionnaire, have an intention to change and are most ready for engagement in self-management efforts.
Methods: This project includes three components: the CPSMP; Move with Ease; and community-level consumer education. Our approach includes crucial partnerships with rural healthcare providers and community pharmacists for referral to County Extension Services (CES). Primary care physicians handle most frontline pain management care. The health care provider will assess a patient and determine if non-opioid options are appropriate. If they are, the health care provider will have the opportunity to refer the patient to the CES office to enroll in classes. Referral from pharmacists will be facilitated by the Community Pharmacy Expanded Services Network (CPESN). Independent and community pharmacies included in CPESN provide Medication Therapy Management services. The pharmacist can engage patients in discussion about treatment options and discern whether referral to the proposed project’s programs such as CPSMP and Move with Ease is of benefit.
Results: Primary participant outcomes will be measured using five instruments: 1) Pain Stages of Change Questionnaire, 2) Brief Pain Inventory – Short Form, 3) Pain Self-Efficacy Questionnaire, 4) Short Form – Health Survey, and 5) Sit-and-Reach functional fitness test. Data will be collected at three points: baseline, end of CPSMP, and 12 weeks after baseline data collection for CPSMP/15 weeks after baseline data collection for Move with Ease. Sufficient data will be collected this spring to report preliminary results at the conference. Implications for an array of audiences will be discussed.
