Empowering Pain Psychology Access and Collaboration (EPPAC) to Improve Treatment Engagement Among Medicaid-insured Adults With Chronic Low Back Pain

Chronic low back pain (cLBP) is a leading cause of disability, with socioeconomically disadvantaged populations experiencing worse outcomes and lower rates of treatment initiation for evidence-based pain psychology services. Participant engagement strategies such as shared decision-making (SDM) and motivational interviewing (MI) have shown promise in improving treatment uptake, but no study has examined whether integrating these approaches into a pain psychology evaluation can improve engagement among socioeconomically disadvantaged participants or offered participants a structured choice between cognitive behavioral therapy (CBT) and emotional awareness and expression therapy (EAET), presented to participants as Pain and Emotion Reprocessing Therapy (PERT). The Empowering Pain Psychology Access and Collaboration (EPPAC) intervention, a brief, psychologist-led engagement strategy combining SDM and MI within a standard pain psychology evaluation, was developed to address this gap.

Inclusion Criteria: * Chronic low back pain lasting at least 3 months and present at least half the days in the past 6 months, with an Oswestry Disability Index (ODI) score of at least 24% * Medicaid insurance as primary or secondary coverage documented in the medical record, including eligible dual Medicare-Medicaid coverage * Able to complete study procedures in English * Able to participate in the telehealth clinical workflow and complete online questionnaires, with telephone assistance when needed Exclusion Criteria: * Specific spinal pathology or medical condition requiring immediate intervention that makes study participation inappropriate * Currently receiving psychological treatment specifically for chronic pain at the time of screening * Lumbar spine surgery within the past 6 months * Severe psychiatric, cognitive, or substance-related condition that interferes with safe participation or meaningful consent * Enrollment in another interventional study for chronic low back pain that could confound study outcomes * Current cancer other than skin cancer