Self-management program ‘offers an important blueprint’ for treatment of chronic pain

Key takeaways:

• STOMP program interventions reduced pain severity both immediately and after 3 months.
• Adjustments to the interventions used in STOMP could make it effective in reducing pain beyond those with HIV.

A self-management program tailored to individuals with HIV significantly reduced the impact and severity of chronic pain, according to results from a randomized study published in JAMA Internal Medicine.

“We are thrilled the [Skills to Manage Pain (STOMP)] intervention — a combination of peer support and pain self-management education — was effective despite lower-than-anticipated adherence, and we were pleased to see it was effective despite pivoting to entirely phone delivery because of the [COVID-19] pandemic,” Katie Fitzgerald Jones, PhD, ACHPN, CARN-AP, a palliative & addiction nurse practitioner with the U.S. Department of Veteran Affairs (VA), told Healio. “We hope STOMP can be offered in HIV clinics across the country.”

According to Fitzgerald Jones and colleagues, the prevalence of chronic pain in people with HIV is somewhere between 30% and 85%. Addressing chronic pain is especially important in that population due to high mental health and substance use disorder rates, “making prescribing opioid pain medication risky,” they added.

In the randomized clinical trial, researchers assigned 278 participants (mean age, 53 years; 45% women) with HIV and moderate chronic pain lasting at least 3 months or more to either the STOMP intervention or enhanced usual care.

In STOMP, participants underwent six one-on-one sessions led by social workers or health educators over 12 weeks. The initial session focused on pain education, whereas subsequent sessions involved several topics — including weight loss, sleep, relaxation, physical activity and talking with friends and family about pain — that were interesting to the participant.

STOMP participants also underwent six 1-hour group sessions during the 12 weeks.

In the enhanced usual care group, participants received only the STOMP manual and a brief overview led by staff.

Pain severity and the impact of pain on function, which the researchers measured with the Brief Pain Inventory (BPI) summary score, served as the study’s primary outcome measurement.

STOMP participants attended a mean 2.9 one-on-one sessions and a mean 2.4 group sessions.

Fitzgerald Jones and colleagues found that, compared with the enhanced usual care group, STOMP participants had significantly lower BPI scores (mean difference = 1.25 points; 95% CI, 1.71 to 0.78) when measured immediately after completion of the program interventions

The association remained statistically significant 3 months after completion of the STOMP program compared with the enhanced usual care group (mean difference in BPI total score = 0.62 points; 95% CI, 1.09 to 0.14).

Researchers also reported improvements among STOMP participants in secondary outcomes, including pain self-efficacy, catastrophic thinking about pain and depression symptoms. However, when assessed 3 months after end of the program interventions, study investigators noted no statistically significant difference between treatment groups regarding catastrophic thoughts about pain or depression symptoms.

Because the program’s interventions had been tailored to individuals with HIV, the study results may not have general applicability to patients with other conditions, according to researchers.

They also cited the study’s short follow-up period as another study limitation.

The study’s findings “underscore that peer support and pain self-management education is essential to coping with chronic pain,” Fitzgerald Jones said.

“Ideally, interventions like STOMP would be readily available and covered by insurance,” she explained. “Nonetheless, there [are] pain-self management tools and peer navigators available in health centers, such as the VA, that primary care providers should leverage to help patient live better with chronic pain.”

Fitzgerald Jones added that the STOMP program, with some adaptations, could have potential for effective chronic pain management in other patient populations.

“A population that shares pain similarity with people with HIV is cancer survivors who also experience high rates of opioid use, pain in multiple body locations, stigma and communication challenges with clinicians,” she said. “We hope to adapt and test STOMP in cancer survivors by recognizing the unique biopsychosocial aspects of living with chronic pain after cancer diagnosis and treatment, and believe this trial offers an important blueprint.”

References:

• STOMPing out pain: Self-management program helps patients with HIV and chronic pain.
  https://www.upmc.com/media/news/071524-stomping-out-pain. Published July 15, 2024. Accessed July 23, 2024.
• Fitzgerald Jones, et al. JAMA Intern Med. 2024;doi:10.1001/jamainternmed.2024.3071.