Manualising Individualised Placement support for people with unemployment due to chronic pain and testing the feasibility of a randomised controlled trial

Chronic pain is pain that persists over months or years and fails to respond to usual pain care. It has many causes but is often musculoskeletal (e.g. back pain). Chronic pain negatively impacts on daily activities, relationships, mood, sleep, overall health and employment. In general, work is good for people: as well as financial wellbeing, it enhances self-worth and confidence and gives status and purpose in society. Unemployment is associated with poorer health and the children of workless adults in turn have poorer health and higher risk of long-term unemployment. Individualised Placement Support (IPS) has been shown to enhance employability of people with severe mental health conditions (such as schizophrenia). Trained vocational advisers (VAs) provide support to patients in finding and retaining a job using motivational interviewing techniques, problem-solving, identification of the skills and capabilities of the individual and using knowledge of local employers and workplaces. Support can be supplemented with skills training such as CV workshops or counselling to overcome low self-esteem. Vocational support is combined with healthcare. This research is to explore whether IPS could benefit people with chronic pain who have many problems similar to those with severe mental illness. Eventually, we would like to undertake a randomised controlled trial (comparing IPS with 'usual care') but before we can do so, there are gaps in our knowledge: 1) Can IPS transfer to people with chronic pain and what changes are needed to make it work? 2) If work is as important as we think for people's health, can we justify using NHS resources to pay for IPS for its health benefits (rather than society's costs). This application seeks funding to do the groundwork before a definitive trial. We plan to interview people who have recently completed IPS to understand what patients think the benefits are of IPS so that we can be certain to measure them. We will also interview VAs to identify what additional training they might need to provide IPS to pain patients and how to best integrate them with pain services. Through focus groups with GPs we will understand what 'usual care' is for unemployed people with chronic pain. From this qualitative work, and working with our patient and public engagement group, we will develop IPS for chronic pain patients and obtain permissions to carry out a small-scale dummy trial (n=80). In this trial we will randomise patients to IPS supported by community pain services. We will explore if we can identify and recruit patients through GP practices in sufficient number, whether they will stay in a trial and complete questionnaires for 12 months, and how they feel about being randomised particularly if they do not get the 'active' IPS. We propose to give 'control' patients a booklet which signposts them to employment and healthcare services but they will not get the support of the VAs integrated with the pain team. After the 'dummy' trial, we will interview a sample of the patients, the VAs and the GPs to evaluate their experiences and further develop our ideas about a possible full trial, what the standardised operating procedures and data collection tools should be, and what data should be collected that is important to patients as well as healthcare staff and will also allow us to find out if IPS is both effective and a cost-effective use of NHS resources for chronic pain patients.