IMproving Pain Using Peer RE-inforced Self-management Skills (IMPPRESS)

• Pain severity [ Time Frame: Change from baseline to 4 month assessment ] [ Designated as safety issue: No ]
  This will be measured by the Brief Pain Inventory (3 items)
  
  

• Pain beliefs and coping measured by the Pain Catastrophizing Scale (10 items) and Centrality of Pain Scale (10 items) [ Time Frame: Baseline and 4 month assessment (final assessment) ] [ Designated as safety issue: No ]
  
• Social Support and Relationships measured by the Multidimensional Scale of Perceived Social Support (12 items) and the Working Alliance Inventory (12 items) [ Time Frame: Baseline and 4 month for SPSS and only 4 month final interview for Working Alliance ] [ Designated as safety issue: No ]
  
• Pain interference [ Time Frame: Change from baseline to 4 month assessment ] [ Designated as safety issue: No ]
  This will be measured by the PROMIS pain measures (12 items)
  
  
• Relationships [ Time Frame: 4 month assessment ] [ Designated as safety issue: No ]
  Measured by the Working Alliance measure (12 items)
  
  

Peer training will consist of 2 core components: 1) How to deliver the pain self-management curriculum; and 2) Peer-support competencies (i.e., "how to be a peer"). After initial training, research personnel will remain in regular contact with peers to answer questions, troubleshoot problems, and facilitate mutual support among peers. Peers will meet as a group with the psychologist for bi-weekly peer supervision either in-person or via teleconference.

The self-management program will be delivered in two phases. Phase 1 will be a 2-hour didactic session led by the study nurse and will parallel the content described for the peers. The pain self-management manual developed for our earlier studies will be used and distributed to the patients. Phase 2 will be additional sessions delivered by peers, over a 4-month period. At the end of the Phase 1 session, the peers will meet their assigned patients. Peers will be assigned 2 patients, and pairings will be made with input from the study nurse and psychologist, with patients and peers being age- and gender-matched to the extent possible.

After their initial face-to-face meeting, peers will be asked to keep in regular contact with patients over a 4-month period. Specifically, peers will contact patients a minimum of bi-weekly via telephone or in-person.

Peers will be asked to review each of the topic areas covered in the self-management manual. Peers will review a different topic each session, ask if the patient has questions, and discuss his or her personal experience with the topic being covered during that session. Modeling what the nurse care manager has done in prior studies, peers will work with patients to help them to set goals and to evaluate whether these goals are realistic. A new goal will be set at each session, with the peer following up on the previous goals with the patient, whether they were accomplished, and if not, possible courses of action (e.g., modifying the goal or offering other advice to accomplish the goal). Throughout these sessions peers will be encouraged to draw on their own experiences and how they personally overcame obstacles and handled setbacks and frustrations. Peers will not advise on or discuss medications or medical questions with patients. If such questions come up, peers will instruct patients to contact their PCPs.