Managing chronic pain in patients undergoing maintenance hemodialysis is a significant challenge. The Pain Coping Skills Training (PCST) intervention was evaluated in a clinical trial published in Journal of the American Medical Association: Internal Medicine to assess its efficacy in reducing pain interference and improving secondary outcomes like anxiety, depression, and quality of life.
The trial enrolled 643 patients, with 319 randomized to the PCST group and 324 to usual care. The PCST intervention included 12 coach-led sessions, complemented by an interactive voice response (IVR) component for 12 weeks. High adherence to the intervention was observed, with participants attending a median of 12 sessions and 61.9% conducted via videoconferencing.
The benefits of PCST extended beyond pain interference. At week 12, participants reported improvements in quality of life and anxiety, with between-group differences of 0.52 (95% CI, 0.04-1.00) and -0.88 (95% CI, -1.70 to -0.05), respectively. By week 24, additional improvements in pain severity, pain catastrophizing, depression, and anxiety were observed. However, by week 36, these effects were less pronounced, except for sustained improvements in pain catastrophizing.
Interestingly, a composite outcome of pain interference and opioid use showed success rates of 50.4% in the PCST group versus 39.6% in usual care at 12 weeks, though the effect waned at later time points. Importantly, no significant differences in adverse events were noted, highlighting the safety and tolerability of PCST compared to pharmacologic interventions.
The trial underscores the potential of PCST to address the multidimensional challenges of chronic pain in dialysis patients. While the observed reduction in pain interference was modest, it represents a meaningful advance given the limited treatment options available. The intervention's positive impact on coexisting conditions like anxiety and depression further highlights its holistic benefits.
This study highlights PCST as a viable nonpharmacologic intervention for managing pain and improving psychological outcomes in patients with end-stage renal disease. Despite the high comorbidity burden and limited response to traditional treatments, PCST demonstrated meaningful benefits with minimal risks. These findings pave the way for integrating PCST into routine care, offering a much-needed alternative for a population with few effective options for symptom management.
Sources: Journal of the American Medical Association: Internal Medicine
