Self-Management Behavioral Interventions May Improve Pain Outcomes in HIV

A self-management intervention may be an effective intervention in people with HIV experiencing chronic pain, according to research results published in JAMA Internal Medicine.¹

Because individuals with HIV have a high prevalence of chronic pain, researchers conducted a randomized clinical trial set out to evaluate the efficacy of the Skills to Manage Pain (STOMP) behavioral self-management intervention compared with enhanced usual care (NCT03692611).

Researchers evaluated the efficacy of a self-managed intervention vs enhanced usual care. | Image Credit: Alrandir - stock.adobe.com

The study cohort included eligible adults with HIV who reported at least 3 months of moderate chronic pain. Participants were recruited from the University of Alabama at Birmingham and the University of North Carolina-Chapel Hill, between August 2019 and September 2022.

A total of 278 participants were randomly assigned 1:1 to receive either STOMP or enhanced usual care (n=139 each). Patients in the STOMP group received a total of 12 sessions, 6 individual and 6 group, alternating weekly for 12 weeks. During the one-on-one individual sessions, participants worked with pain coaches to build pain self-management skills. During group sessions, participants received peer support related to chronic pain.² Individuals in the enhanced usual control group received the STOMP manual and a brief staff-led program overview, but no group or individual sessions.

The primary study outcome was pain severity and the impact of pain on function, measured via the Brief Pain Inventory summary score.

READ MORE: Pharmacists Champion Nonopioid Pain Management Strategies

At baseline, sociodemographic characteristics, pain characteristics, history of long-term opioid use, and primary and secondary outcome scores were similar across both groups. A majority of participants identified as Black or African American (81%); the mean age was 53.3±10 years, and 53% were men. At the time of study enrollment, 78% of participants reported multisite pain and 23.5% self-reported long-term use of opioids. The average pain rating was moderate (average Brief Pain Inventory score, 6.4±1.1 points), and the most common pain locations were lower back (75.5%), knee (54%), and numbness or tingling in the hands and feet (52.5%).

The STOMP intervention was associated with a statistically significant mean difference in Brief Pain Inventory Score compared with enhanced usual care (-1.25; 95% CI, -1.71 to -0.78) immediately after the intervention. At 3 months after the intervention, the mean difference in Brief Pain Inventory score remained statistically significant in favor of the STOMP intervention (-0.62; 95% CI, -1.09 to -0.14).

Investigators also noted differences in Brief Pain Inventory-pain severity score (-1.10), Brief Pain Inventory-functional interference score (-1.52), Pain, Enjoyment of Life, and General Activity scale (-1.34), Patient Health Questionnaire Depression Scale (PHQ-8; -2.27), Pain Self-Efficacy Questionnaire (4.10), and Pain Catastrophizing Scale (-4.22). Between-group differences persisted at 3 months for Brief Pain Inventory-pain severity, Brief Pain Inventory-functional interference, Pain, Enjoyment of Life, and General Activity scale, and Pain-Self Efficacy Questionnaire.

Study limitations included the specificity of the patient population, limiting generalizability to individuals with chronic pain without HIV; the short postintervention follow-up period; and that less than half of the study participants were women, also potentially limiting generalizability.

“STOMP may be an efficacious chronic pain intervention for people with HIV,” the investigators wrote. “STOMP…also has the potential to be tailored to other highly affected groups including cancer survivors, older adults, or veterans who frequently experience chronic multisite pain.”

READ MORE: Nonopioid Pain Management Resource Center

References

1. Jones KF, Long DM, Bair MJ, et al. Efficacy of a pain self-management intervention tailored to people with HIV: A randomized controlled trial. JAMA Internal Med. 2024;184(9):1074-1082. doi:10.1001/jamainternmed.2024.3081

2. Merlin JS, Westfall AO, Long D, et al. A randomized pilot trial of a novel behavioral intervention for chronic pain tailored to individuals with HIV. AIDS Behav. 2018;22(8):2733-2742. doi:10.1007/s10461-018-2028-2