The impact of pain on daily life is reduced by behavioral intervention in renal failure patients on dialysis
December 30, 2024
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Monday, December 30, 2024
An NIH-funded study confirms the benefits of training people to cope with pain in populations with limited treatment options.
Pain interference, or pain coping skills training, is a psychological treatment that reduces the amount of pain in people with kidney failure dependent on dialysis. This National Institutes of Health-funded clinical trial found that teaching people to cope with pain decreased the amount of pain affecting their mood and relationships, as well as how they interact at work, in social situations, or at work. Pain coping skills, tailored for people on long-term kidney dialysis, improved pain severity and other symptoms of chronic pain. The pain coping skills approach is widely used to treat chronic pain. However, it has not been evaluated for dialysis patients.
The study's lead author, Dr. Paul Kimmel of the NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), said very few interventions have been proven effective in improving the quality of life of people with end-stage kidney disease on dialysis. The side effects of opioids, a common treatment for chronic pain, can worsen in patients with kidney failure, complicating pain management.
In the United States, more than 808,000 people have end-stage kidney disease. Of these patients, 68 are on dialysis. Dialysis-dependent kidney failure patients often experience chronic pain but have few options for pain relief. Adhering to pain management plans during dialysis can also be difficult. The Hemodialysis Opioid Prescription Effort (HOPE) consortium, the study's research group, aimed to create a behavioral treatment that would reduce the perception of chronic pain and improve the quality of life of hemodialysis patients. This is the largest randomized controlled trial demonstrating the benefits of a nonpharmacological pain intervention for people with end-stage kidney disease on dialysis.
Six hundred and forty-three adults with chronic pain and maintenance dialysis were included in the multicenter study. The trial involved 643 adults receiving maintenance dialysis for end-stage kidney disease and suffering from chronic pain. Approximately half of the participants received the intervention in the form of pain coping skills training, while the other half continued to receive their usual clinical treatment without any intervention based on the trials. Pain coping skills training consisted of 12-week virtual individual sessions with a coach to improve self-efficacy, reduce anxiety and stress, and teach pain coping skills. The intervention included guided practice and experiential training, as well as instruction and skill modeling. After the coach-led session, 12 weeks were spent using automated interactive voice responses to refresh newly learned skills.
The benefit of pain management skills training continued throughout the 24-week intervention. At week 12, 51 % reported reduced pain interference, compared to 37 % in the usual care group. By week 36, 12 weeks after the intervention ended, the difference between the two groups had narrowed. Researchers believe that those receiving pain coping skills training may need reinforcement to gain additional benefits or benefit for a longer period of time. Pain coping skills improved pain-related outcomes for pain severity, depression, and anxiety, as well as quality of life and pain catastrophizing.
According to the study, pain coping skills training could be a good alternative or complementary treatment to pain relievers. The overall effect of pain coping skills training was small, but its acceptability, safety, and tolerability, as well as its benefits on pain, anxiety, depression, and quality of life in dialysis patients, support future research.
Laura M. Dember is a nephrologist at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. She was the lead author of the study. We hope that, based on the positive results of this research, this treatment can be offered to all dialysis patients.
Study, The Hemodialysis Prescription Effort The Hemodialysis Pain and Opioid Reduction Consortium trial was funded by There is a long-term initiative to help end drug addictionNIH HEAL initiative, an NIH effort to accelerate scientific solutions to the epidemic of overdoses, opioid and stimulant addiction disorders, and chronic pain.
The Department of Health and Human Services has registered the trademarks Helping to end Addiction Long-term (r) and NIH HEAL initiative(r).
The NIDDK, part of the NIH, conducts research and provides support for kidney, urologic, and hematologic diseases, as well as diabetes, digestive disorders, nutrition, and obesity. These diseases affect people from all walks of life and are among the most serious and common conditions affecting Americans. See the NIDDK for more information. www.niddk.nih.gov.
The National Institutes of Health: The NIH is the medical research agency of the U.S. Department of Health and Human Services. It comprises 27 institutes and centers. The NIH, the nation's medical research agency, comprises 27 institutes and centers and is part of the U.S. Department of Health and Human Services. Visit the NIH website for more information about its programs and services. www.nih.gov.
NIH…Transforming Discovery into Healthcare(r)
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