ArticlePloS one2026
Expanding rural access to chronic pain care through nurse care management: A hybrid type I effectiveness-implementation trial protocol.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06407115 (Expanding Rural Access to Chronic Pain Care Through Nurse Care Management), which is not on this map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Expanding Rural Access to Chronic Pain Care Through Nurse Care Management
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Authors and funding
16 authors.
Funding
Abstract
backgroundChronic pain affects more than 20% of U.S. adults, with prevalence approaching 30% in rural communities. It can substantially impair physical functioning, mental health, and quality of life, and rural residents experience poorer pain-related outcomes. Effective care requires a comprehensive, multidisciplinary approach; however, rural primary care clinicians often rely on medications-particularly prescription opioids-as the predominant treatment despite limited evidence and substantial risks. Innovative strategies are needed to expand access to evidence-based, non-pharmacologic pain management in rural settings.
objectiveTo determine the effectiveness of a nurse care management (NCM) model for chronic pain compared with usual care and to evaluate its implementation.
methodsA pragmatic, hybrid type I effectiveness-implementation randomized controlled trial will be conducted from April 2026 to July 2028. A total of 450 adults with chronic pain and a Pain, Enjoyment of Life, and General Activity (PEG) scale total score ≥12 will be recruited from rural health systems. Rural eligibility will be verified using the Health Resources and Services Administration (HRSA) Rural Health Grants Eligibility Analyzer. Participants will be randomly assigned to the NCM intervention or to usual care using permuted block randomization with variable block sizes (4 or 6). The 6-month virtually delivered NCM intervention includes (1) cognitive behavioral therapy, (2) care coordination, and (3) referral to Tele-Enhance®Fitness, an instructor-led virtual group exercise program. The primary outcome is pain interference and intensity measured by the PEG scale. Secondary outcomes include pain catastrophizing, depression, anxiety, physical functioning, sleep disturbance, satisfaction with health, and opioid use. Implementation outcomes-reach, fidelity, feasibility, and sustainment-will be evaluated with the Practical, Robust Implementation and Sustainability Model (PRISM) framework. DISCUSSION: This pragmatic trial will assess the effectiveness of the NCM model for chronic pain care and collect implementation data to guide potential scale-up in rural primary care.
trial registrationClinicalTrials.gov identifier: NCT06407115.
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