Abstract: SA-OR94
Pain Coping Skills Training for Patients Receiving Hemodialysis: The HOPE Consortium Randomized Clinical Trial
Session Information
- High-Impact Clinical Trials - 2
October 26, 2024 | Location: Hall D, Convention Center
Abstract Time: 11:30 AM - 11:45 AM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Dember, Laura M., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Hsu, Jesse Yenchih, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Mehrotra, Rajnish, University of Washington, Seattle, Washington, United States
- Cavanaugh, Kerri L., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Kalim, Sahir, Massachusetts General Hospital, Boston, Massachusetts, United States
- Charytan, David M., New York University Grossman School of Medicine, New York, New York, United States
- Fischer, Michael J., University of Illinois Hospital & Health Sciences System, Chicago, Illinois, United States
- Jhamb, Manisha, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Johansen, Kirsten L., Hennepin Healthcare System Inc, Minneapolis, Minnesota, United States
- Becker, William, Yale University School of Medicine, New Haven, Connecticut, United States
- Keefe, Francis J., Duke University School of Medicine, Durham, North Carolina, United States
- White, David M., American Association of Kidney Patients, Tampa, Florida, United States
- Kimmel, Paul L., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
- Cukor, Daniel, New York University Grossman School of Medicine, New York, New York, United States
Group or Team Name
- HOPE Consortium.
Background
Chronic pain is common among individuals undergoing maintenance hemodialysis and contributes to poor quality of life, depression, and anxiety. Pharmacologic management of pain is challenging in this patient population.
Methods
In this multicenter randomized controlled 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 primary outcome was pain interference measured by the Brief Pain Inventory (BPI) Interference subscale at 12, 24, and 36 weeks, with change from baseline to 12 weeks serving as the primary endpoint. Secondary outcomes included pain intensity, pain catastrophizing, quality of life, depression, and anxiety.
Results
643 patients enrolled at 16 centers and 103 affiliated dialysis facilities were randomized to pain coping skills training (319 participants) or usual care (324 participants), yielding a cohort with 44.8% female, 45.9% Black, and 18.5% Hispanic participants. At Week 12 (primary endpoint), the pain coping skills training group had a larger reduction in the BPI Interference score compared with usual care [between-group difference (95% CI) -0.49 (-0.85, -0.12); p=0.009]. The effect persisted at Week 24 [difference -0.48 (-0.86, -0.11)] but was diminished at Week 36 [difference -0.34 (-0.72, 0.04)]. A decrease in BPI Interference ≥1 point (minimal clinically important difference) occurred in 50.9% of those in pain coping skills training vs 36.6% in usual care at 12 weeks [OR (95% CI) 1.79 (1.28, 2.49)], and 55.0% vs 42.8% at 24 weeks [OR 1.59 (1.13, 2.24)]. Favorable changes with the intervention were also apparent for secondary outcomes of pain intensity, quality of life, depression, and anxiety at Weeks 12 and/or 24, and for pain catastrophizing at Weeks 24 and 36.
Conclusion
Among patients undergoing maintenance hemodialysis, pain coping skills training had benefits on pain interference and other pain-associated outcomes. Clinicaltrials.gov NCT04571619
Funding
- NIDDK Support