# An adaptive walking intervention to manage chronic pain in veterans with opioid use disorder engaged in opioid agonist treatment

> **NIH VA IK2** · VA CONNECTICUT HEALTHCARE SYSTEM · 2024 · —

## Abstract

Compared to a civilian population, Veterans have particularly high rates of severe chronic pain and
Opioid Use Disorder (OUD). Prevalence of chronic pain in individuals with OUD remains high despite
engagement in opioid agonist treatment (OAT), the first line treatment for OUD, consisting of buprenorphine or
methadone. Chronic pain treatment in the Veterans Health Administration (VHA) has recently shifted to
promoting non-pharmacologic approaches to treat chronic pain; however, individuals with OUD are often
excluded from pain treatment clinical trials. Among individuals with chronic pain and OUD receiving OAT, the
most commonly reported pain coping strategies are prayer, over the counter medication, and opioid
medication. There is an immediate need to develop evidence-based pain treatments for chronic pain that can
be integrated into OAT for Veterans with chronic pain and OUD.
 The gold standard non-pharmacologic treatment for chronic pain is cognitive behavioral therapy (CBT)
for chronic pain. Despite having a favorable view of non-pharmacologic pain treatment, many OAT clinics lack
adequate staffing training and resources for intensive pain treatment such as CBT. Furthermore, Veterans are
often hesitant to seek care in pain specialty clinics due to stigma (e.g., drug-seeking behavior) and frequent
OAT dosing visits. Walking is a core component of CBT for chronic pain and has demonstrated effectiveness
at reducing pain in chronic pain patients. More specifically, walking has been identified as a low-cost, highly
accessible intervention that has been shown to reduce pain, disability, and increase quality of life in individuals
with chronic pain but has not been tested in Veterans with OUD engaged in OAT.
The proposed study will determine feasibility, acceptability, and preliminary efficacy for Steps to
Change (S2C), a behavioral pain treatment that includes biopsychosocial pain education and an adaptive
walking program. Importantly, S2C will be offered within in the Veteran’s OAT clinic to increase access and
encourage treatment engagement. Pain interference (primary outcome) collected using ecological momentary
assessment (EMA), where behavior is repeatedly sampled using a mobile device. The use of EMA to measure
pain interference offers considerable benefits to in-clinic measurement including significantly reducing recall
bias and substantially improving reliability of measurement. Daily steps will be measured using a study
provided pedometer and entered in end of day EMA surveys. Sixty Veterans will be randomized to either 1)
S2C or 2) health education control each consisting of 4x60 minute weekly groups in the OAT clinic. All
participants will complete EMA surveys for 8 weeks (1-week baseline, 4-week treatment, and 1-week post, 3-
and 6-month follow up). We predict that study procedures will be feasible with timely randomization,
comparable retention and EMA survey completion between treatment groups. We also predict that Veterans in
both gr...

## Key facts

- **NIH application ID:** 10731390
- **Project number:** 5IK2CX002286-03
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** Robert Ross MacLean
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10731390

## Citation

> US National Institutes of Health, RePORTER application 10731390, An adaptive walking intervention to manage chronic pain in veterans with opioid use disorder engaged in opioid agonist treatment (5IK2CX002286-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10731390. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*