The Motivational Interviewing and Cognitive Behavioral Therapy for Chronic Pain (MI+CBT-CP) intervention is an empirically based behavioral pain management behavioral therapy intervention, including MI to enhance motivation for active participation in the CBT-CP, and the use of CBT-CP to enhance pain coping skills. MI + CBT-CP participants received one MI session plus up to eight weekly CBT-CP group sessions.

The primary outcome was derived from electronic health records. Total morphine equivalents for each prescription was calculated by multiplying the quantity of each prescription by the strength of the prescription (milligrams of opioid per unit dispensed). The quantity-strength product was then multiplied by conversion factors to estimate the milligrams of morphine equivalent to the opioids dispensed in the prescription. The total average dose in morphine equivalents per day supplied was calculated by summing the morphine equivalents for each prescription filled during a given period and dividing by the number of days supplied. Opioid dose was calculated as the prescribed milligrams of daily morphine equivalent dose averaged over the 90 days prior to randomization and averaged over 90 days for the time period of 9 months post-randomization. Change in daily opioid dose was computed as the difference between the dose calculated during that period and the dose from the baseline period.

The primary outcome was derived from electronic health records. Total morphine equivalents for each prescription was calculated by multiplying the quantity of each prescription by the strength of the prescription (milligrams of opioid per unit dispensed). The quantity-strength product was then multiplied by conversion factors to estimate the milligrams of morphine equivalent to the opioids dispensed in the prescription. The total average dose in morphine equivalents per day supplied was calculated by summing the morphine equivalents for each prescription filled during a given period and dividing by the number of days supplied. Opioid dose was calculated as the prescribed milligrams of daily morphine equivalent dose averaged over the 90 days prior to randomization and averaged over 90 days for the time period of 15 months post-randomization. Change in daily opioid dose was computed as the difference between the dose calculated during that period and the dose from the baseline period.

The primary outcome was derived from electronic health records. Total morphine equivalents for each prescription was calculated by multiplying the quantity of each prescription by the strength of the prescription (milligrams of opioid per unit dispensed). The quantity-strength product was then multiplied by conversion factors to estimate the milligrams of morphine equivalent to the opioids dispensed in the prescription. The total average dose in morphine equivalents per day supplied was calculated by summing the morphine equivalents for each prescription filled during a given period and dividing by the number of days supplied. Opioid dose was calculated as the prescribed milligrams of daily morphine equivalent dose averaged over the 90 days prior to randomization and averaged over 90 days for the time period of 18 months post-randomization. Change in daily opioid dose was computed as the difference between the dose calculated during that period and the dose from the baseline period.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

The Patient-Reported Outcomes Measurement Information System - Pain Interference (PROMIS-PI) is a validated, self-reported instrument assessing pain interference over the past 7 days. Pain interference is a measure of the extent to which pain interferes with patient physical, mental, and social activities. Possible scores on each item range in value from 1 (not at all) to 5 (very much). Higher T-scores indicate higher pain interference and worse health. Change = Month 12 Score - Baseline Score.

The Patient-Reported Outcomes Measurement Information System - Physical Functioning (PROMIS-PF) is a validated, self-reported instrument assessing physical functioning over the past 7 days. Physical functioning measures one's upper extremities (dexterity), lower extremities (walking and mobility), central regions (back and neck), and instrumental activities of daily living.

Possible scores on each item range in value from 1 (without any difficulty) to 5 (unable to do). Higher T-scores indicate higher physical functioning and better health. Change = Month 6 Score - Baseline Score.

The Patient-Reported Outcomes Measurement Information System - Physical Functioning (PROMIS-PF) is a validated, self-reported instrument assessing physical functioning over the past 7 days. Physical functioning measures one's upper extremities (dexterity), lower extremities (walking and mobility), central regions (back and neck), and instrumental activities of daily living.

Possible scores on each item range in value from 1 (without any difficulty) to 5 (unable to do). Higher T-scores indicate higher physical functioning and better health. Change = Month 12 Score - Baseline Score.

The Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity is a validated, self-reported instrument assessing pain intensity over the past 7 days. Possible scores on each item range in value from 1 (no pain) to 5 (very severe). Higher T-scores indicate higher pain intensity and worse health. Change = Month 12 Score - Baseline Score.

The Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Anxiety is a validated, self-reported instrument assessing anxiety over the past 7 days. Anxiety measures self-reported fear, anxiety, hyperarousal, and somatic symptoms related to arousal. Anxiety is best differentiated by symptoms that reflect autonomic arousal and experience of threat. Possible scores on each item range in value from 1 (never) to 5 (always). Higher T-scores indicate higher anxiety and worse health. Change = Month 6 Score - Baseline Score.

The Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Anxiety is a validated, self-reported instrument assessing anxiety over the past 7 days. Anxiety measures self-reported fear, anxiety, hyperarousal, and somatic symptoms related to arousal. Anxiety is best differentiated by symptoms that reflect autonomic arousal and experience of threat. Possible scores on each item range in value from 1 (never) to 5 (always). Higher T-scores indicate higher anxiety and worse health. Change = Month 12 Score - Baseline Score.

The Patient-Reported Outcomes Measurement Information System (PROMIS)-Emotional Distress-Depression is a validated, self-reported instrument assessing depression over the past 7 days. Depression measures self-reported negative mood, views of self, social cognition, and decreased positive affect and engagement. Possible scores on each item range in value from 1 (never) to 5 (always). Higher T-scores indicate higher depression and worse health. Change = Month 6 Score - Baseline Score.

The Patient-Reported Outcomes Measurement Information System (PROMIS)-Emotional Distress-Depression is a validated, self-reported instrument assessing depression over the past 7 days. Depression measures self-reported negative mood, views of self, social cognition, and decreased positive affect and engagement. Possible scores on each item range in value from 1 (never) to 5 (always). Higher T-scores indicate higher depression and worse health. Change = Month 12 Score - Baseline Score.

The Brief Pain Inventory (BPI) Pain Severity is a validated, self-reported instrument assessing pain severity at its worst and least in the past 7 days, on average, and right now. Possible scores on each item range from 0 (no pain) to 10 (pain as bad as you can imagine). Higher scores indicate higher pain severity and worse health. Change = Month 6 Score - Baseline Score.

The Brief Pain Inventory (BPI) Pain Severity is a validated, self-reported instrument assessing pain severity at its worst and least in the past 7 days, on average, and right now. Possible scores on each item range from 0 (no pain) to 10 (pain as bad as you can imagine). Higher scores indicate higher pain severity and worse health. Change = Month 12 Score - Baseline Score.

The Brief Pain Inventory (BPI) Pain Interference is a validated, self-reported instrument assessing pain interference over the past 7 days in 7 categories: general activity, walking, work, mood, enjoyment of life, relation with others, and sleep. Possible scores on each item range from 0 (does not interfere) to 10 (completely interferes). Higher scores indicate higher pain interference and worse health. Change = Month 6 Score - Baseline Score.

The Brief Pain Inventory (BPI) Pain Interference is a validated, self-reported instrument assessing pain interference over the past 7 days in 7 categories: general activity, walking, work, mood, enjoyment of life, relation with others, and sleep. Possible scores on each item range from 0 (does not interfere) to 10 (completely interferes). Higher scores indicate higher pain interference and worse health. Change = Month 12 Score - Baseline Score.

Discontinuation of opioid medications at Month 12 was assessed with a self-reported item newly developed for this study and electronic health record (EHR) data. Discontinuation was defined as a response of "No" to a question on the Month 12 participant survey that asked: "Are you currently taking an opioid medicine now? Commonly prescribed opioids include hydrocodone, oxycodone, codeine, morphine, and fentanyl" AND no opioid prescriptions in the EHR within 15 days prior to Month 12 through Month 18.

Intent to Taper was assessed with a self-reported item, newly developed for this study, that assessed intent to reduce the amount of opioids taken: "Please say how much you agree with this statement: 'Reducing the amount of opioid medicines I take is a goal of mine.'" Possible response options included Strongly Agree, Agree, Uncertain, Disagree, and Strongly Disagree. Responses of Strongly Agree or Agree were categorized as an intent to taper, and responses of Uncertain, Disagree, Strongly Disagree, or Don't Know were categorized as no intent to taper.

Intent to Taper was assessed with a self-reported item, newly developed for this study, that assessed intent to reduce the amount of opioids taken: "Please say how much you agree with this statement: 'Reducing the amount of opioid medicines I take is a goal of mine.'" Possible response options included Strongly Agree, Agree, Uncertain, Disagree, and Strongly Disagree. Responses of Strongly Agree or Agree were categorized as an intent to taper, and responses of Uncertain, Disagree, Strongly Disagree, or Don't Know were categorized as no intent to taper.

Opioid use relative to baseline was assessed with a self-reported item, newly developed for this study: "Since you started taking part in this study, would you say that your overall use of opioids has increased, stayed about the same, or decreased? In thinking about your "overall use" we ask you consider how often you take the opioid medicine, the different types of opioid medicines, and their amounts." Possible response options included: My overall use of opioids has increased; My overall use of opioids has stayed about the same; and My overall use of opioids has decreased.

Opioid use relative to baseline was assessed with a self-reported item, newly developed for this study: "Since you started taking part in this study, would you say that your overall use of opioids has increased, stayed about the same, or decreased? In thinking about your "overall use" we ask you consider how often you take the opioid medicine, the different types of opioid medicines, and their amounts." Possible response options included: My overall use of opioids has increased; My overall use of opioids has stayed about the same; and My overall use of opioids has decreased.

Shared Decision Making (SDM) participants received guideline-concordant pharmacotherapy based on clinical guidelines for opioid therapy for chronic noncancer pain plus the SDM intervention during their opioid management visits. Participants in the SDM arm received their regular pain care visits with a designated SDM-trained clinician over a 12-month period. SDM intervention participants scheduled pain visits as often as needed for pain management (typically quarterly). SDM participants also received an electronic and physical packet of educational materials after randomization.

Total of all reporting groups

The Health Literacy Skills Instrument was used to assess participant health literacy in terms of print literacy (reading and writing), numeracy skills, oral literacy skills (listening), and information seeking (navigation of Internet and facilities). The version used in the study had 5 questions.

Health literacy level was classified into 3 categories: High Health Literacy (all 5 questions correct), Average Health Literacy (3 or 4 questions correct), and Low Health Literacy (0 to 2 questions correct). Missing responses were counted as incorrect.

Average daily opioid dose was derived from electronic health records. Dose is reported in morphine milligram equivalents (MME), a standardized measure that accounts for differences in opioid prescription strength, quantity, and potency relative to morphine. Baseline average daily opioid dose was calculated as the prescribed daily MME averaged over the 90 days prior to randomization. Higher MME values indicate greater opioid dosage prescribed.

Eleven participants did not have an opioid prescription during the baseline period (defined as 3 months before enrollment): 5 had an opioid prescribed at an outside clinic and later transferred to the study clinic, 4 received an opioid just before the baseline period, and 2 received a type of opioid (e.g., injectable) that was not included in the study.

The PROMIS Pain Interference 8-item scale is a validated, self-reported instrument assessing pain interference over the past 7 days. Pain interference is a measure of the extent to which pain interferes with patient physical, mental, and social activities. Responses were scored using the PROMIS scoring system to generate a standardized T-score, allowing comparison to the general population (mean = 50, standard deviation = 10). Higher T-scores indicate higher pain interference and worse health.

The PROMIS Physical Functioning measure is a validated, self-reported instrument assessing physical functioning over the past 7 days. Physical functioning measures one's upper extremities (dexterity), lower extremities (walking and mobility), central regions (back and neck), and instrumental activities of daily living. Responses were scored using the PROMIS scoring system to generate a standardized T-score, allowing comparison to the general population (mean = 50, SD = 10). Higher T-scores indicate higher physical functioning and better health.

The BPI Pain Severity scale is a validated, self-reported measure assessing pain severity at its worst and least in the past 7 days, on average, and right now. Possible scores on each item range from 0 (no pain) to 10 (pain as bad as you can imagine). Higher scores indicate higher pain severity and worse health. The scores were averaged to generate a composite score from 0 to 10. BPI pain severity categories are defined as Mild (0 to 3.5), Moderate (3.5 to 7.4), and Severe (7.5 to 10).

Presence of any of the following mental health disorder diagnoses in the participant's electronic health record: adjustment disorder, anxiety, attention-deficit/hyperactivity disorder, dementia, developmental disorder, childhood disorders, impulse control disorder, mood disorder, personality disorder, schizophrenia or other psychotic disorder, suicidal ideation, and other miscellaneous mental health disorders.

Presence of any of the following conditions in the participant's electronic health record: myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, rheumatic disease, peptic ulcer disease, mild liver disease, diabetes without complications, diabetes with complications, paraplegia and hemiplegia, renal disease, cancer, moderate or severe liver disease, metastatic carcinoma, or AIDS/HIV. These conditions make up the Charlson Comorbidity Index, a measure of overall health status and mortality risk.

Presence of any substance use disorder diagnoses in the participant's electronic health record.

The primary outcome was derived from electronic health records. Total morphine equivalents for each prescription was calculated by multiplying the quantity of each prescription by the strength of the prescription (milligrams of opioid per unit dispensed). The quantity-strength product was then multiplied by conversion factors to estimate the milligrams of morphine equivalent to the opioids dispensed in the prescription. The total average dose in morphine equivalents per day supplied was calculated by summing the morphine equivalents for each prescription filled during a given period and dividing by the number of days supplied. Opioid dose was calculated as the prescribed milligrams of daily morphine equivalent dose averaged over the 90 days prior to randomization and averaged over 90 days for the time period of 3 months post-randomization. Change in daily opioid dose was computed as the difference between the dose calculated during that period and the dose from the baseline period.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

The primary outcome was derived from electronic health records. Total morphine equivalents for each prescription was calculated by multiplying the quantity of each prescription by the strength of the prescription (milligrams of opioid per unit dispensed). The quantity-strength product was then multiplied by conversion factors to estimate the milligrams of morphine equivalent to the opioids dispensed in the prescription. The total average dose in morphine equivalents per day supplied was calculated by summing the morphine equivalents for each prescription filled during a given period and dividing by the number of days supplied. Opioid dose was calculated as the prescribed milligrams of daily morphine equivalent dose averaged over the 90 days prior to randomization and averaged over 90 days for the time period of 6 months post-randomization. Change in daily opioid dose was computed as the difference between the dose calculated during that period and the dose from the baseline period.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

The primary outcome was derived from electronic health records. Total morphine equivalents for each prescription was calculated by multiplying the quantity of each prescription by the strength of the prescription (milligrams of opioid per unit dispensed). The quantity-strength product was then multiplied by conversion factors to estimate the milligrams of morphine equivalent to the opioids dispensed in the prescription. The total average dose in morphine equivalents per day supplied was calculated by summing the morphine equivalents for each prescription filled during a given period and dividing by the number of days supplied. Opioid dose was calculated as the prescribed milligrams of daily morphine equivalent dose averaged over the 90 days prior to randomization and averaged over 90 days for the time period of 9 months post-randomization. Change in daily opioid dose was computed as the difference between the dose calculated during that period and the dose from the baseline period.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

The primary outcome was derived from electronic health records. Total morphine equivalents for each prescription was calculated by multiplying the quantity of each prescription by the strength of the prescription (milligrams of opioid per unit dispensed). The quantity-strength product was then multiplied by conversion factors to estimate the milligrams of morphine equivalent to the opioids dispensed in the prescription. The total average dose in morphine equivalents per day supplied was calculated by summing the morphine equivalents for each prescription filled during a given period and dividing by the number of days supplied. Opioid dose was calculated as the prescribed milligrams of daily morphine equivalent dose averaged over the 90 days prior to randomization and averaged over 90 days for the time period of 15 months post-randomization. Change in daily opioid dose was computed as the difference between the dose calculated during that period and the dose from the baseline period.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

The primary outcome was derived from electronic health records. Total morphine equivalents for each prescription was calculated by multiplying the quantity of each prescription by the strength of the prescription (milligrams of opioid per unit dispensed). The quantity-strength product was then multiplied by conversion factors to estimate the milligrams of morphine equivalent to the opioids dispensed in the prescription. The total average dose in morphine equivalents per day supplied was calculated by summing the morphine equivalents for each prescription filled during a given period and dividing by the number of days supplied. Opioid dose was calculated as the prescribed milligrams of daily morphine equivalent dose averaged over the 90 days prior to randomization and averaged over 90 days for the time period of 18 months post-randomization. Change in daily opioid dose was computed as the difference between the dose calculated during that period and the dose from the baseline period.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

Dichotomous variable indicating a decrease of 10 MME or more from baseline to 12 months (1=yes and 0 =no). Modeled the probability of having a 10 or more MME decrease from baseline.

Intent-to-treat population; those missing EHR prescription data at a certain timepoint did not contribute data for that timepoint in the mixed repeated measures model.

The Patient-Reported Outcomes Measurement Information System - Pain Interference (PROMIS-PI) is a validated, self-reported instrument assessing pain interference over the past 7 days. Pain interference is a measure of the extent to which pain interferes with patient physical, mental, and social activities. Possible scores on each item range in value from 1 (not at all) to 5 (very much). Higher T-scores indicate higher pain interference and worse health. Change = Month 6 Score - Baseline Score.

Intent-to-treat population among those that completed a 6-month survey. 1 participant in the SDM arm did not complete the entire 6-month survey, but did complete the PROMIS Pain Interference section of the survey and was included in the analysis.

The Patient-Reported Outcomes Measurement Information System - Pain Interference (PROMIS-PI) is a validated, self-reported instrument assessing pain interference over the past 7 days. Pain interference is a measure of the extent to which pain interferes with patient physical, mental, and social activities. Possible scores on each item range in value from 1 (not at all) to 5 (very much). Higher T-scores indicate higher pain interference and worse health. Change = Month 12 Score - Baseline Score.

Intent-to-treat population among those that completed a 12-month survey. 1 participant in the CBT arm and 5 in the SDM arm did not complete the entire 12-month survey, but did complete the PROMIS Pain Interference section of the survey and were included in the analysis.

The Patient-Reported Outcomes Measurement Information System - Physical Functioning (PROMIS-PF) is a validated, self-reported instrument assessing physical functioning over the past 7 days. Physical functioning measures one's upper extremities (dexterity), lower extremities (walking and mobility), central regions (back and neck), and instrumental activities of daily living.

Possible scores on each item range in value from 1 (without any difficulty) to 5 (unable to do). Higher T-scores indicate higher physical functioning and better health. Change = Month 6 Score - Baseline Score.

Intent-to-treat population among those that completed a 6-month survey.

The Patient-Reported Outcomes Measurement Information System - Physical Functioning (PROMIS-PF) is a validated, self-reported instrument assessing physical functioning over the past 7 days. Physical functioning measures one's upper extremities (dexterity), lower extremities (walking and mobility), central regions (back and neck), and instrumental activities of daily living.

Possible scores on each item range in value from 1 (without any difficulty) to 5 (unable to do). Higher T-scores indicate higher physical functioning and better health. Change = Month 12 Score - Baseline Score.

Intent-to-treat population among those that completed a 12-month survey. 1 participant in the CBT arm and 5 in the SDM arm did not complete the entire 12-month survey, but did complete the PROMIS Physical Functioning section of the survey and were included in the analysis.

The Patient-Reported Outcomes Measurement Information System (PROMIS)-Pain Intensity is a validated, self-reported instrument assessing pain intensity over the past 7 days. Possible scores on each item range in value from 1 (no pain) to 5 (very severe). Higher T-scores indicate higher pain intensity and worse health. Change = Month 6 Score - Baseline Score.

Intent-to-treat population among those that completed a 6-month survey. 1 participant in the SDM arm did not complete the entire 6-month survey, but did complete the PROMIS Pain Intensity section of the survey and was included in the analysis.

The Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity is a validated, self-reported instrument assessing pain intensity over the past 7 days. Possible scores on each item range in value from 1 (no pain) to 5 (very severe). Higher T-scores indicate higher pain intensity and worse health. Change = Month 12 Score - Baseline Score.

Intent-to-treat population among those that completed a 12-month survey. 1 participant in the CBT arm and 3 in the SDM arm did not complete the entire 12-month survey, but did complete the PROMIS Pain Intensity section of the survey and were included in the analysis.

The Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Anxiety is a validated, self-reported instrument assessing anxiety over the past 7 days. Anxiety measures self-reported fear, anxiety, hyperarousal, and somatic symptoms related to arousal. Anxiety is best differentiated by symptoms that reflect autonomic arousal and experience of threat. Possible scores on each item range in value from 1 (never) to 5 (always). Higher T-scores indicate higher anxiety and worse health. Change = Month 6 Score - Baseline Score.

Intent-to-treat population among those that completed a 6-month survey. 1 participant in the SDM arm did not complete the entire 6-month survey, but did complete the PROMIS Anxiety section of the survey and was included in the analysis.

The Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Anxiety is a validated, self-reported instrument assessing anxiety over the past 7 days. Anxiety measures self-reported fear, anxiety, hyperarousal, and somatic symptoms related to arousal. Anxiety is best differentiated by symptoms that reflect autonomic arousal and experience of threat. Possible scores on each item range in value from 1 (never) to 5 (always). Higher T-scores indicate higher anxiety and worse health. Change = Month 12 Score - Baseline Score.

Intent-to-treat population among those that completed a 12-month survey. 3 participants in the SDM arm did not complete the entire 12-month survey, but did complete the PROMIS Anxiety section of the survey and were included in the analysis.

The Patient-Reported Outcomes Measurement Information System (PROMIS)-Emotional Distress-Depression is a validated, self-reported instrument assessing depression over the past 7 days. Depression measures self-reported negative mood, views of self, social cognition, and decreased positive affect and engagement. Possible scores on each item range in value from 1 (never) to 5 (always). Higher T-scores indicate higher depression and worse health. Change = Month 6 Score - Baseline Score.

Intent-to-treat population among those that completed a 6-month survey.

The Patient-Reported Outcomes Measurement Information System (PROMIS)-Emotional Distress-Depression is a validated, self-reported instrument assessing depression over the past 7 days. Depression measures self-reported negative mood, views of self, social cognition, and decreased positive affect and engagement. Possible scores on each item range in value from 1 (never) to 5 (always). Higher T-scores indicate higher depression and worse health. Change = Month 12 Score - Baseline Score.

Intent-to-treat population among those that completed a 12-month survey. 3 participants in the SDM arm did not complete the entire 12-month survey, but did complete the PROMIS Depression section of the survey and were included in the analysis.

The Brief Pain Inventory (BPI) Pain Severity is a validated, self-reported instrument assessing pain severity at its worst and least in the past 7 days, on average, and right now. Possible scores on each item range from 0 (no pain) to 10 (pain as bad as you can imagine). Higher scores indicate higher pain severity and worse health. Change = Month 6 Score - Baseline Score.

Intent-to-treat population among those that completed a 6-month survey.

The Brief Pain Inventory (BPI) Pain Severity is a validated, self-reported instrument assessing pain severity at its worst and least in the past 7 days, on average, and right now. Possible scores on each item range from 0 (no pain) to 10 (pain as bad as you can imagine). Higher scores indicate higher pain severity and worse health. Change = Month 12 Score - Baseline Score.

Intent-to-treat population among those that completed a 12-month survey. 3 participants in the SDM arm did not complete the entire 12-month survey, but did complete the BPI Pain Severity section of the survey and were included in the analysis.