For the 30 percent of Americans who experience chronic pain, many patients turn to their primary care providers for pain management and treatment. These clinicians are often faced with the decision to select from a variety of treatment options while also considering a patient's history, their symptoms, risks and benefits of available options, and the overall goal of treating the patient. Meanwhile, the ongoing efforts to address the public health crisis of opioid misuse has seen a decline in opioid prescribing among providers. Clinical experts have expressed concerns of such efforts for patients who are impacted by the decrease in opioid prescribing, specifically among patients who may benefit from opioid-related treatment. With many options to consider when treating a patient with chronic pain, primary care providers would greatly benefit from tools to facilitate decision making around appropriate treatment plans that consider a patient’s history and input, along with the balance of risks and benefits.

Patient-centered clinical decision support (CDS) for the shared decision making process could aid primary care providers and their patients in chronic pain treatment plan selection. The research team will implement and evaluate AHRQ’s interoperable CDS tool, Pain Manager, with the overall goals of increasing shared decision making and improving patient outcomes.

The specific aims of the research are as follows:

• Adapt and tailor Pain Manager, AHRQ’s interoperable CDS tool, for implementation in primary care clinics affiliated with the OneFlorida Clinical Research Consortium.
• Evaluate the effect of tailored implementation support on Pain Manager’s adoption for pain treatment shared decision making.
• Establish the feasibility of and obtain preliminary data in preparation for a multisite pragmatic trial targeting the effectiveness of Pain Manager and tailored implementation support on shared decision making and patient-reported pain and physical function.

The researchers will first tailor the functionality and user interface of the existing Pain Manager tool through a series of interviews and design sessions with both patients and primary care clinicians. They will then implement the tool in electronic health records across eight clinics within the OneFlorida Clinical Research Consortium system to support shared decision making for pain treatment. In a randomized staggered rollout approach, the CDS tool implementation will consist of training, technical assistance, and workflow assessments. The research team will conduct a mixed-methods study and evaluate the implementation process by assessing adaptation, feasibility, and contextual factors.

The research team expects the tailored implementation support will increase CDS adoption and shared decision making, leading to improved chronic pain management and patient outcomes. These anticipated outcomes will inform the importance of tailored implementation and the benefits of technology to improve care for chronic pain.