Published in the JAMA Internal Medicine. Here is a link to the article.
Regenstrief Institute authors: Matthew J. Bair, M.D., M.S.
Importance
Chronic pain is a common condition for which efficacious interventions tailored to highly affected populations are urgently needed. People with HIV have a high prevalence of chronic pain and share phenotypic similarities with other highly affected populations.
Objective
To evaluate the efficacy of a behavioral pain self-management intervention called Skills to Manage Pain (STOMP) compared to enhanced usual care (EUC).
Design, Setting, and Participants
This randomized clinical trial included adults with HIV who experienced at least moderate chronic pain for 3 months or more. The study was set at the University of Alabama at Birmingham and the University of North Carolina–Chapel Hill large medical centers from August 2019 to September 2022.
Intervention
STOMP combined 1-on-1 skill-building sessions delivered by staff interventionists with group sessions co-led by peer interventionists. The EUC control group received the STOMP manual without any 1-on-1 or group instructional sessions.
Main Outcomes and Measures
The primary outcome was pain severity and the impact of pain on function, measured by the Brief Pain Inventory (BPI) summary score. The primary a priori hypothesis was that STOMP would be associated with a decreased BPI in people with HIV compared to EUC.
Results
Among 407 individuals screened, 278 were randomized to STOMP intervention (n = 139) or EUC control group (n = 139). Among the 278 people with HIV who were randomized, the mean (SD) age was 53.5 (10.0) years; 126 (45.0%) identified as female, 146 (53.0%) identified as male, 6 (2.0%) identified as transgender female. Of the 6 possible 1-on-1 sessions, participants attended a mean (SD) of 2.9 (2.5) sessions. Of the 6 possible group sessions, participants attended a mean (SD) of 2.4 (2.1) sessions. Immediately after the intervention compared to EUC, STOMP was associated with a statistically significant mean difference for the primary outcome, BPI total score: −1.25 points (95% CI, −1.71 to −0.78 points; P < .001). Three months after the intervention, the mean difference in BPI total score remained statistically significant, favoring the STOMP intervention −0.62 points (95% CI, −1.09 to −0.14 points; P = .01).
Conclusion and Relevance
The findings of this randomized clinical trial support the efficaciousness of STOMP as an intervention for chronic pain in people with HIV. Future research will include implementation studies and work to understand the optimal delivery of the intervention.
Authors:
Katie Fitzgerald Jones, PhD, ACHPN, CARN-AP1; Dustin M. Long, PhD2; Matthew J. Bair, MD, MS3; Deana Agil, MR4; Lindsay Browne, BA4; Greer Burkholder, MD, MS5; Olivio J. Clay, PhD6; Kendall Conder, BS4; Amy L. Durr, MA, MSN, RN, FNP-BC4; Claire E. Farel, MD, MPH4; Kiko King, PhD, MCHES5; Bernadette Johnson, BS5; Jane M. Liebschutz, MD, MPH7; William Demonte, PsyD8; Mireille Leone, BA4; LaToya Mullen, MPH, CHES9; Sarah Margaret Orris, BS7; Tammi Thomas, BS5; Mallory Johnson, PhD, MA10; Sonia Napravnik, PhD4; Jessica S. Merlin, PhD, MD, MBA7
Affiliations:
1New England Geriatric Research Education and Clinical Center, Section of Palliative Care, VA Boston Healthcare System, Boston, Massachusetts
2Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
3VA HSR&D Center for Health Information and Communication, Department of Medicine, Indiana University School of Medicine, Indianapolis
4Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
5Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham
6Department of Psychology, University of Alabama at Birmingham
7Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
8Virginia Mason Franciscan Health, Bonney Lake, Washington
9Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of North Carolina at Chapel Hill
10Center for AIDS Prevention Studies, University of San Francisco, San Francisco, California
