Equity Using Interventions for Pain and Depression (EQUIPD): A pilot randomized trial

Abstract

Despite increased calls for improved health equity, Black patients continue to experience worse pain and associated outcomes. Black patients are also offered fewer pain treatment options than White patients and report poorer quality communication with clinicians, including lower participation in shared decision-making. Comorbid depressive symptoms can impede effective pain management and participation in decision-making. The Equity Using Interventions for Pain and Depression (EQUIPD; NCT05695209) pilot study examined feasibility of a one-on-one coaching intervention, paired with a decision aid, to facilitate shared decision-making about evidence-based nonpharmacological pain treatments for Black patients with chronic musculoskeletal pain and symptoms of at least mild depression. We recruited and randomized 30 participants at a rate of 7.5 per month, with 90% retention at 3 months and 87% at 6 months. Intervention participation was high, with 94% of participants completing at least 3 of 4 coaching sessions. Fidelity was also high. Although not powered for effectiveness, most outcomes, including pain interference, depression, anxiety, patient engagement, and shared decision-making, improved, favoring the intervention, with effect sizes ranging from 0.30–0.75 at 3 months. Results indicate that EQUIPD holds promise as an intervention to support autonomy and shared decision-making for Black patients with chronic pain and elevated depressive symptoms.

Perspective

The EQUIPD intervention, which included one-on-one coaching combined with a decision aid to increase shared decision-making about nonpharmacological pain treatments, was feasible and shows promise in improving pain and related outcomes for Black patients with chronic musculoskeletal pain and depressive symptoms.