Cognitive behavioral intervention helped reduce pain in hemodialysis patients

A cognitive behavioral intervention modestly improved pain interference and other pain-associated outcomes among people with kidney failure receiving maintenance hemodialysis, a clinical trial found.

Investigators randomized 643 participants (mean age, 60.3 years; 44.8% female) at 16 academic centers and 103 outpatient dialysis facilities to receive training on pain coping skills or usual care (no trial-driven pain intervention). All participants were adults undergoing maintenance hemodialysis and experiencing chronic pain. The 36-week trial began in January 2021, and follow-up ended in December 2023. The intervention consisted of 12 weekly coach-led sessions via video or telephone conferencing, followed by 12 weeks of daily interactive voice response sessions. The primary outcome was pain interference measured with the Brief Pain Inventory Interference subscale, with higher scores indicating more pain interference. Pain intensity, pain catastrophizing, quality of life, depression, and anxiety were secondary outcomes. Findings were published by JAMA Internal Medicine on Dec. 30, 2024.

A total of 319 patients were assigned to the training and 324 to usual care. After 12 weeks, the intervention group had a larger reduction in the pain interference score than the usual care group (between-group difference, −0.49 [95% CI, −0.85 to −0.12]; P=0.009). Results were consistent at week 24 (between-group difference, −0.48; 95% CI, −0.86 to −0.11) but diminished at week 36 (between-group difference, −0.34; 95% CI, −0.72 to 0.04). At 12 weeks, 50.9% of patients in the training group had at least a one-point drop in the interference score, compared with 36.6% of patients in the usual care group (odds ratio, 1.79; 95% CI, 1.28 to 2.49). At 24 weeks, the percentages were 55% and 42.8%, respectively (odds ratio, 1.59; 95% CI, 1.13 to 2.24). Favorable changes in pain intensity, quality of life, depression, and anxiety at weeks 12 and/or 24, as well as for pain catastrophizing at weeks 24 and 36, were seen in the group that got training.

Limitations include that patient-reported outcomes were not collected from around 10% of participants at week 12 and around 20% of participants at later time points, in large part because of participant death. The researchers also noted that they did not incorporate a cost-effectiveness analysis into the trial.

“While the effect on the overall cohort was of modest magnitude, the intervention resulted in a clinically meaningful improvement in pain interference for a substantial proportion of participants,” the authors wrote. “Centrally administered [pain coping skills training] may provide a low-risk, scalable approach for people with dialysis-dependent kidney failure, a population with limited options for managing pain.”