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RETOUCH: Rural Engagement To Optimize Understanding, Care and Help for Patients with Chronic Pain

This study will address the following PCORI priority question: Among patients with chronic noncancer pain on moderate/high dose long-term opioid therapy, what is the comparative effectiveness of strategies for reducing/eliminating opioid use while managing pain? In a two-arm cluster randomized control trial, we will determine the effectiveness of a sleep health intervention compared to a sleep health plus yoga intervention in primary care settings to improve patient-reported outcomes and stabilize or reduce levels of long-term opioid medication use among rural patients with chronic pain. Nearly 20% of the U.S. population lives in rural communities and that percentage is higher in the Midwest region of the country. These under-resourced areas often have too few health professionals to meet their community's needs. Health disparities among rural residents are in part driven by isolation and limited access to primary care and in part a set of behaviors that increase risk of injury and poor overall heath status. As a social determinant of health, rurality is a significant and independent factor in opioid prescribing patterns putting this group of citizens at risk; research suggests that rural Americans are almost three times more likely that non-rural citizens to be prescribed an opioid for chronic noncancer pain. This pattern may exist not because of decisional uncertainty for clinicians on what may be best for patients but because they lack community and other resources available for alternative, complementary and non-medication strategies for treatment. Engaging rural primary care physicians and offering patients resources holds the promise of improving patient safety and curbing unnecessary and potentially detrimental opioid-centric pain care.


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