Pain coping skills can reduce pain in patients receiving hemodialysis: HOPE Consortium Randomized Trial
Presenter: Laura M. Dember, MD, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Among patients undergoing maintenance hemodialysis, pain coping skills training can improve pain-associated outcomes at 12 weeks, according to the HOPE Consortium Randomized Trial.
Pain coping skills can significantly reduce the pain experienced by patients undergoing maintenance hemodialysis, according to data from the HOPE Consortium Randomized Trial presented at the Kidney Week 2024. Overall, 60% of this patient population report pain; however, pain management is a challenge because of heterogeneous etiologies, medication toxicities, concurrent depression, anxiety and frailty, lack of expertise by nephrologists in pain management, and limited access for patients to non-nephrologist care providers, said abstract author Laura M. Dember, MD, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
In the multicenter randomized controlled HOPE trial, patients undergoing hemodialysis and experiencing chronic moderate or severe pain were randomly assigned 1:1 to a cognitive behavioral intervention called Pain Coping Skills Training or to usual care. The intervention consisted of 12 weeks of remotely delivered coach-led sessions followed by 12 weeks of daily telephone-based interactive voice response sessions. The outcome measured was change in pain interference measured by the Brief Pain Inventory (BPI) Interference subscale (0-10 with higher score indicating more pain interference) from baseline to weeks 12, 24, and 36 weeks.
HOPE investigators enrolled 643 patients (44.8% female, 45.9% Black, and 18.5% Hispanic) at 16 centers and 103 affiliated dialysis facilities, with 319 randomized to pain coping skills training and 324 to usual care. At week 12 (primary outcome), the pain coping skills training group had a significantly larger reduction in the BPI Interference score compared with usual care (between-group difference minus 0.49; 95% CI minus 0.85 to minus 0.12; P = .009). The effect persisted at week 24 (difference minus 0.48; 95% CI minus 0.86 to minus 0.11) but was diminished at week 36 (difference minus 0.34; 95% CI minus 0.72 to minus 0.04).
A decrease in BPI Interference scores of 1 point or less (minimal clinically important difference) occurred in 50.9% of those in pain coping skills training versus 36.6% in usual care at 12 weeks (OR 1.79; 95% CI 1.28-2.49), and 55.0% versus 42.8% at 24 weeks (OR 1.59; 95% CI 1.13-2.24). The absolute difference of 14% (relative difference 40%) for the training versus usual care, yielded a number needed to treat of 7. Benefits were also apparent for the secondary outcomes of pain severity, pain catastrophizing, depression, anxiety, and quality of life.
The intervention, Dr. Dember concluded, resulted in a clinically meaningful improvement for a substantial proportion of participants. “The efficacy, acceptability, and safety of the intervention support future work to develop strategies for adopting pain coping skills training in dialysis clinical care.”
Funding
- NIDDK Support