Sequenced Care Pathway vs Pain Navigator Pathway for Veterans With Low Back Pain: The AIM-Back Cluster Randomized...

Area of Science:

• Pain Management
• Clinical Trials
• Health Services Research

Background:

• Low back pain (LBP) is a significant cause of disability worldwide.
• Evidence supporting alternative care models for LBP is limited.
• Effective management strategies for LBP are crucial for improving patient outcomes and reducing healthcare burden.

Purpose of the Study:

• To compare the effectiveness of a sequenced care pathway (SCP) against a pain navigator pathway (PNP) for patients with low back pain.
• To evaluate which care pathway leads to better outcomes in pain interference and physical function.
• To assess secondary outcomes including sleep disturbance and pain intensity.

Main Methods:

• An embedded cluster randomized clinical trial involving 19 Veterans Health Administration primary care clinics.
• 1817 participants with LBP were randomized to either SCP or PNP.
• Primary outcomes (pain interference, physical function) were assessed using PROMIS-SF at 3 months via electronic health records.

Main Results:

• No significant difference was found between the SCP and PNP for the primary outcomes of pain interference and physical function at 3 months.
• The mean difference in pain interference was -0.6 points (SCP vs. PNP) and 0.6 points for physical function.
• No significant differences were observed in secondary outcomes between the two pathways.

Conclusions:

• The sequenced care pathway (SCP) was not superior to the pain navigator pathway (PNP) in improving pain interference and physical function for patients with LBP.
• Future research should focus on optimizing pathway adherence and exploring patient-level factors influencing treatment response.
• Investigating the effectiveness of these pathways in diverse settings is recommended.