PROJECT SUMMARY Despite a range of therapeutic approaches, chronic musculoskeletal pain (CMP) persists at a high rate, creating a public health burden. Our long-term goal is to increase access and scalability of evidence-based interventions while addressing pain care disparities for rural individuals with limited resources and/or endure long distances to specialty pain care. We will conduct a hybrid implementation-effectiveness trial, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework in diverse healthcare systems and communities across the United States in Texas and South Carolina focusing on rural health populations. Specifically, in our UG3 phase, we aim to plan and evaluate our Auricular Point Acupressure Self-Management (APA-SM) program integrated into rural health care and communities. Our team has accumulated extensive evidence supporting the use of APA-SM in decreasing pain intensity, reducing pain interference, and improving physical function. To maximize self-management of pain, we successfully developed and tested a smartphone APA app, an integral component of our APA-SM program, so patients can learn to self-administer APA. We also used ecological momentary assessment integrated into our app to measure real-world outcomes with participants able to self-monitor their progress using this as an innovative behavior change strategy. Our APA-SM program is theory-based according to Bandura’s self-efficacy model, toward successful initiation and maintenance of participants’ behavior change. In the UG3 phase, we will work with the NIH Pragmatic Trials Collaboratory Coordinating Center and collaborate extensively with our stakeholders to plan, implement, evaluate, and sustain our intervention. In the UH3 phase, using a pragmatic, randomized clinical trial, we will evaluate the clinical effectiveness of our 4-week APA-SM program. We will compare 3 groups: self-guided APA-SM, APA-SM + in-person training, and education control. The primary outcomes are pain intensity, pain interference, and function; the secondary outcomes are based on the HEAL Clinical Pain Core common data elements, and analgesic use, up to a 6-month follow-up. We will also evaluate implementation outcomes, cost-effectiveness, and predictive factors for APA-SM treatment response. A two-phase design in our UH3 will include an initiation (support for buy-in) and maintenance (no support provided) phase.

PROJECT NARRATIVE Chronic pain is a major health concern and places an enormous burden on society and healthcare systems in the U.S., especially in rural areas. This project aims to plan and test auricular point acupressure self- management (APA-SM) integrated into primary care. We will conduct a real-world trial to evaluate clinical effectiveness, implementation outcomes, and cost-effectiveness toward revolutionizing pain management particularly for rural populations.