# Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE)

> **NIH VA I01** · RLR VA MEDICAL CENTER · 2021 · —

## Abstract

Background: Chronic pain affects 40-70% of Veterans and amounts to over $600 billion/year in direct medical
costs and lost worker productivity. Racial disparities in pain treatment have been extensively documented.
Minority patients, including Veterans, are more likely to be undertreated for pain. Minority Veterans have pain
documented less frequently, undergo more urine drug tests, and are more likely to be referred for substance
abuse evaluation than White Veterans. Compounding these pain care disparities, minority Veterans exhibit
lower levels of patient activation than Whites. Patient activation—having knowledge, confidence, and skills to
manage health—is associated with better health experiences, self-management, and outcomes. Low activation
is frequently manifested in poorer communication among minority patients. Minority patients are less likely to
share their concerns with providers, ask questions, and prepare for their clinic visits. This poor communication
is associated with lower quality care, poorer patient-provider relationships, and treatment non-adherence. The
poorer communication experienced by minorities is exacerbated by the documented difficulties in patient-
provider communication about chronic pain and its treatment—particularly where opioids are concerned.
Objectives: COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain
with Equity) is a pragmatic randomized controlled trial of an intervention to improve patient activation and
communication with providers for Black Veterans with chronic pain. COOPERATE focuses on 2 essential skill
sets necessary to facilitate effective patient activation: 1) goal-setting and prioritization, and 2) communication
skills. COOPERATE is delivered over the telephone in 6 sessions (4 weekly sessions followed by 2 booster
session) over a period of 12 weeks. The primary study outcome is patient activation.
Methods: COOPERATE is a Hybrid Type 1 study, designed to test effectiveness while also examining
implementation facilitators and barriers. COOPERATE will enroll 250 Black Veterans with chronic
musculoskeletal pain from primary care clinics. Veterans will be randomized either to the COOPERATE
intervention or to an attention control arm. For Aim 1 we will test the effects of COOPERATE at 3 (primary end
point), 6, and 9 months (sustained effects) on patient activation (primary outcome), communication self-
efficacy, pain intensity and interference, and psychological functioning. Aim 2 will examine patient activation as
a mediator of clinical outcomes, and working alliance as a moderator of COOPERATE’s effect on patient
activation. In Aim 3, our pre-implementation aim, we will use qualitative methods to understand facilitators and
barriers to implementing COOPERATE. Guided by the RE-AIM framework, we will interview a purposefully
selected subsample of intervention Veterans, and clinicians from primary care and the chronic pain clinic, to
better prepare for COOPERATE’s...

## Key facts

- **NIH application ID:** 10213832
- **Project number:** 5I01HX002392-04
- **Recipient organization:** RLR VA MEDICAL CENTER
- **Principal Investigator:** Marianne S Matthias
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-07-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10213832

## Citation

> US National Institutes of Health, RePORTER application 10213832, Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE) (5I01HX002392-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10213832. Licensed CC0.

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