Johns Hopkins University
Chronic low back pain (cLBP) is a leading cause of disability, with socioeconomically disadvantaged populations experiencing worse outcomes and lower rates of treatment initiation for evidence-based pain psychology services. Participant engagement strategies such as shared decision-making (SDM) and motivational interviewing (MI) have shown promise in improving treatment uptake, but no study has examined whether integrating these approaches into a pain psychology evaluation can improve engagement among socioeconomically disadvantaged participants or offered participants a structured choice between cognitive behavioral therapy (CBT) and emotional awareness and expression therapy (EAET), presented to participants as Pain and Emotion Reprocessing Therapy (PERT). The Empowering Pain Psychology Access and Collaboration (EPPAC) intervention, a brief, psychologist-led engagement strategy combining SDM and MI within a standard pain psychology evaluation, was developed to address this gap.
Chronic low back pain (cLBP) is among the leading causes of disability worldwide, affecting approximately 12.8 million adults in the United States. Individuals with low socioeconomic status (SES) are disproportionately affected, with roughly twice the rate of developing cLBP compared with higher-SES populations. The investigator's prior work has shown that socioeconomically disadvantaged adults with cLBP report worse pain-related outcomes than more advantaged counterparts, underscoring the need for effective and accessible treatments in this population. Clinical practice guidelines recommend…
Inclusion Criteria: * Chronic low back pain lasting at least 3 months and present at least half the days in the past 6 months, with an Oswestry Disability Index (ODI) score of at least 24% * Medicaid insurance as primary or secondary coverage documented in the medical record, including eligible dual Medicare-Medicaid coverage * Able to complete study procedures in English * Able to participate in the telehealth clinical workflow and complete online questionnaires, with telephone assistance when needed Exclusion Criteria: * Specific spinal pathology or medical condition requiring immediate i…
EPPAC is a brief, psychologist-led engagement strategy embedded within a standard pain psychology evaluation. It combines motivational interviewing and shared decision-making, structured pain education, a patient decision aid, two decision points, balanced discussion of CBT and EAET (presented to participants as PERT), and next-step planning to support informed engagement in pain psychology care.
Usual care consists of the clinic's standard pain psychology evaluation and usual discussion of clinical recommendations and treatment options. It does not include the EPPAC-specific decision aid, standardized EPPAC pain education, exact Decision Point 1 question, or EPPAC next-steps probe. CBT and EAET, presented to participants as PERT, are downstream clinical treatment options available in both study arms.
Arctuva estimate
Verify or correct the compensation shown for this listing.