Motivational Interviewing Targeting Pain and Substance Use in Veterans Seeking Service-Connection Payments: A Multisite Randomized Clinical Trial

Abstract Background Veterans filing musculoskeletal disorder (MSD) service claims may also be seeking medical treatment. Objective To determine the effect of Motivational Interviewing to Activate Pain Support (MAPS) on pain and substance use in veterans who recently filed MSD claims. Participants A total of 1101 post 9/11 veterans who had filed MSD compensation claims, were not receiving multimodal pain care from VA and had at least moderately severe pain. Interventions Up to five phone sessions of MAPS compared to treatment-as-usual (TAU). Main Measures Pain severity subscale of the Brief Pain Inventory (BPI) and number of substances above the low-risk threshold of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Key Results Most (87%) veterans offered MAPS participated, and counselors delivered MAPS with good integrity. At week 36, MAPS participants had significantly greater reductions in pain severity than TAU (−0.78 vs. −0.53; mean difference = −0.25, 95% CI −0.44 to −0.06, p = .011), although rates of clinically meaningful improvement were similar between groups (45.4% MAPS vs. 40.8% TAU; OR = 1.21, 95% CI 0.92–1.59, p = .183). The groups did not differ in self-reported number of pain treatment modalities used (TAU = 3.01 modalities vs. MAPS 3.33 modalities, p = .135); however, MAPS participants had, on average, 54% more outpatient encounters for MSDs than those in TAU (MAPS 7.25 vs. TAU 4.58, p < .001). Substance use did not differ between groups. Conclusions MAPS was associated with more outpatient encounters for MSD and statistically significant reductions in pain severity at week 36; reductions achieving the threshold for clinical significance did not differ by group. Benefits from MAPS, despite pandemic-era disruptions to treatment availability, may have occurred via counselors activating patients to seek MSD treatments, helping them navigate pain care systems, and offering patients support. Design Two-arm, parallel group 36-week multisite randomized pragmatic clinical trial (Clinical Trials.gov: NCT 04062214). Trial Registration ClinicalTrials.gov registration (NCT04062214) on August 19, 2019.