Novel Program Helps People With HIV Manage Chronic Pain

A novel behavioral pain management program reduced pain severity and pain-related functional interference in people living with HIV, according to a randomized clinical trial.

The Skills to Manage Pain (STOMP) program was associated with a mean difference of -1.25 in the Brief Pain Inventory (BPI) total score (scale of 0-10) when compared with enhanced usual care (P<0.001), Katie Fitzgerald Jones, PhD, ACHPN, CARN-AP, of the VA Boston Healthcare System, and colleagues reported in JAMA Internal Medicine.

“For many patients, this is the difference between being able to visit a loved one, go to the grocery store, do laundry, or attend a child’s basketball game,” Fitzgerald Jones told MedPage Today.

Among participants in the STOMP group, 37% had a greater than 30% improvement in the BPI total score compared with 20% in the enhanced usual care group (P=0.01).

Researchers also found other positive impacts of the intervention, including a -1.10 difference in BPI-pain severity (P<0.001) and a -1.52 difference in BPI-functional interference (P<0.001) scores between the STOMP group and enhanced usual care.

The results appeared to be somewhat durable, as the mean difference in BPI total score between the two groups remained statistically significant 3 months after the intervention at -0.62, favoring the STOMP intervention (P=0.01).

Significant improvements were also seen in the STOMP group over enhanced usual care after the intervention on the Pain, Enjoyment of Life and General Activity scale (P<0.001); Patient Health Questionnaire depression scale (P<0.001); Pain Self-Efficacy Questionnaire (P=0.02); and Pain Catastrophizing Scale (P=0.005). At 3 months, the differences between the intervention group and the enhanced usual care group remained statistically significant, except for pain catastrophizing and mood scores, the authors noted.

The authors said these results suggest STOMP may be as efficacious as pharmacologic treatments for chronic pain.

“I am not surprised to see that regular peer-led and social work-led interventions resulted in improvement in pain management outcomes,” Cathy Creticos, MD, director of infectious diseases at Howard Brown Health in Chicago, told MedPage Today. “These allow patients to deal with the social and behavioral aspects of living with HIV, like loneliness, feelings of self-worth, etc., in a way that encourages them to work with peers to visualize a path towards pain management alongside independence and self-confidence.”

“People living with HIV are unique with regards to pain management for numerous reasons,” Creticos explained. “HIV itself, as well as many of the medicines used to treat it, causes peripheral neuropathy.” Also, this population disproportionately deals with stigma, isolation, and depression, as well as substance use and post-traumatic stress disorder, she pointed out.

“Due to all these reasons, HIV is a source of chronic pain for many patients … and living with HIV can provide many barriers to traditional pain management care,” Creticos said.

The study included 278 people with HIV and was conducted at two large medical centers from August 2019 to September 2022. Due to the COVID-19 pandemic, the intervention pivoted to a remote format in March 2020. The mean age was 53.5 years and 45% identified as female. A majority (81%) were Black or African American.

At baseline, 78% had multisite pain and nearly one in four reported long-term opioid use. The mean BPI-total score was 6.4, reflecting moderate-to-severe pain. Back pain, knee pain, and neuropathic pain were experienced by a majority of participants.

The STOMP intervention was based on social cognitive principles and involved six one-on-one sessions led by trained social workers and health educators that alternated with six trained peer- and staff-led group sessions over a 12-week period.

Participant attendance to the STOMP intervention was low, Fitzgerald Jones acknowledged, with a mean attendance of only 2.9 out of the six one-on-one sessions and 2.4 of the six group sessions. Of note, 24% of participants attended no sessions.

“We were surprised that STOMP was effective despite lower-than-anticipated adherence,” Fitzgerald Jones said. “And we were pleased to see it was effective despite pivoting to entirely phone delivery” because of the pandemic.

“The biggest issue I can foresee is around implementation,” Creticos commented. “In particular, this treatment could prove to be very costly because peers, trainers, and/or social workers involved in the interventions would need to be trained and retained.” But the benefits could be worthwhile if there is a reduced dependency on pain medications, she noted.

Although 187 adverse events occurred during the study — mostly under the categories of illness, injury, and surgery — none were associated with the intervention.

Among the limitations cited by the authors were the short follow-up period and that less than half of participants were women.

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