Health Coaching for Chronic Multi-symptom Illness

Chronic pain is one of the most extensive health care issues facing our society with “severe impacts on all aspects of the lives of its sufferers.” Pain predominant chronic multisymptom illness (Pain-CMI, e.g., fibromyalgia) is a particularly debilitating and treatment resistant chronic pain condition and a presumptive service connected condition for Veterans who deployed to the Gulf region from 1990-2021. The VA/DoD Guidelines recommend non-pharmaceutical treatments (e.g., cognitive behavioral therapy) for Pain-CMI and find evidence they improve disability (typically) by targeting the mechanisms underlying Pain-CMI (e.g., low perceived pain control, catastrophizing and limiting activity). While no single treatment is (or is likely to be) acceptable, available and efficacious for all Veterans, having a wide array of treatment options facilitates Veterans’ uptake of non-pharmaceutical approaches. Health coaching is an appealing potential approach to improve the disability of Pain-CMI because it has high acceptability and it will be widely available as the VA is rolling out health coaching for other conditions (high availability). The goal of this proposal is to understand if health coaching is also efficacious for complex pain condition, Pain-CMI. Health coaching has high acceptability because it addresses what experts, clinicians and patients agree is a driver of low satisfaction and adherence - disagreement between the patient and providers about the cause of and best approaches for Pain-CMI. In health coaching, the health coach elicits the Veteran’s beliefs and uses these to develop a shared understanding of Pain-CMI. The health coach then identifies discrepancies between where in life the Veteran is and where the Veteran wants to be. Motivational interviewing, goal setting and problem-solving are used to help the Veteran reduce these discrepancies. The goal of the current proposal is to conduct a randomized clinical trial to determine the efficacy of remote-delivered health coaching to reduce the disability and pain impairment for Veterans with Pain-CMI as compared to supportive psychotherapy (n=250), and to explore mechanisms of change. The VA has already rolled out whole health coaching approaches for other conditions. Thus, if found to be efficacious, our health coaching intervention can be taught to VA whole health coaches and providers nationally. This would increase access to care for Veterans with Pain-CMI. The VA WRIISC,28 which is mandated by Congress to provide leadership and expertise in CMI, is closely following our efforts to guide their decisions and potential national implementation of health coaching for Pain-CMI. There is a desperate need for empirical data to guide these decisions.