Chronic musculoskeletal pain creates a significant public health burden, and Veterans are disproportionately affected. The frequency and extent of co-occurrence of pain and PTSD, pain and Traumatic Brain Injury (TBI), all three conditions (Post-deployment Multi-symptom Disorder (PMD), and other multi-symptom syndromes can complicate and reduce the effectiveness of pain treatment. Furthermore, the majority of Veterans do not seek care in VA settings, requiring an approach that will be available to all Veterans. The Blueprint for Relieving Pain in America and National Pain Strategy call for the promotion of self-management; reducing disparities among vulnerable subgroups (e.g., Veterans); and the tailoring of pain care. Proponents of integrated treatment for common co-morbid conditions are advocating for interventions that address multiple conditions. This Phase II proposal builds on a successful NACTS-funded Phase I SBIR that developed and pilot tested a theoretically-grounded, mobile- optimized, interactive pain self-management intervention for Veterans with chronic musculoskeletal pain. Health eRide: Your Journey to Managing Pain 1) was tailored specifically to Veterans' readiness and preferred strategies for pain self-management; 2) leveraged SMS messaging, social networking, and gaming principles to increase engagement and retention; and 3) helped to address the co-occurrence of PTSD and TBI by including health behavior change messages for sleep hygiene and stress management. At 30-day follow-up, participants (n=44) reported significant reductions in pain and pain impact, as well as increased readiness to employ self-management strategies. Over 68% of participants reported favorable global impression of change. Phase II will involve 1) completing the development of Health eRide by transforming it into an app and enhancing its functionality for mobile browsers, enhancing the social networking and gaming features, and adding e-coaching capabilities; and 2) conducting a year- long randomized trial in which 540 Veterans with chronic pain recruited from both VA facilities and the community are randomly assigned to Health eRide or an online educational cognitive- behavioral therapy intervention. Differences in pain intensity and interference will be examined at 6 months (immediately post-intervention) and 12-months. A number of secondary analyses will be conducted to examine the impact Health eRide has on other outcomes (e.g., PTSD symptoms). A successful trial will set the stage for widespread dissemination of an efficacious, easily accessible tailored pain self-management intervention to address an urgent need among our nation's Veterans as well as an adaptation for general adult populations.

Relevance: Chronic pain, and in particular, chronic musculoskeletal pain is all too common (especially among Veterans) and imposes enormous costs on patients, society, and the health care system. The proposed research will conduct a rigorous scientific study of the effects of a pain self-management program that 1) provides feedback uniquely matched to an individual Veteran's readiness to use helpful pain coping skills, improve sleep habits, and manage stress; 2) can be used as a mobile phone app or on any computer, tablet, or mobile device; 3) interfaces with social networking sites; 4) includes personalized text messages or push notifications; and 5) uses principles of gaming for health to engage users. This intervention offers a cost-effective, science-based, and easily deliverable solution to entire populations to increase self-management, reduce pain, and improve functioning and well-being.