Pain Coping Skills Training for Patients Receiving Hemodialysis, 2024, Mehrotra et al

Pain Coping Skills Training for Patients Receiving Hemodialysis
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2828284

Abstract

Importance: Chronic pain is common among individuals with dialysis-dependent kidney failure.

Objective: To evaluate the effectiveness of pain coping skills training (PCST), a cognitive behavioral intervention, on pain interference.

Design, Setting, and Participants: This multicenter randomized clinical trial of PCST vs usual care was conducted across 16 academic centers and 103 outpatient dialysis facilities in the US. Adults undergoing maintenance hemodialysis and experiencing chronic pain were randomly assigned to PCST or usual care in a 1:1 ratio. Participants were followed in the trial for 36 weeks. Enrollment began on January 4, 2021, and follow-up ended on December 21, 2023.

Interventions: PCST consisting of 12 weekly coach-led sessions via video or telephone conferencing, followed by 12 weeks of daily interactive voice response sessions. Usual care had no trial-driven pain intervention.

Main Outcomes: The primary outcome was pain interference measured with the Brief Pain Inventory (BPI) Interference subscale (score range of 0-10, with higher scores indicating more pain interference). Secondary outcomes included pain intensity, pain catastrophizing, quality of life, depression, and anxiety.

Results: A total of 643 participants (mean [SD] age, 60.3 [12.6] years; 288 [44.8%] female) were randomized, with 319 assigned to PCST and 324 assigned to usual care. At week 12 (primary end point), the PCST group had a larger reduction in the BPI Interference score than the usual care group (between-group difference, −0.49; 95% CI, −0.85 to −0.12; P = .009). The effect persisted at week 24 (between-group difference in BPI Interference score, −0.48; 95% CI, −0.86 to −0.11) but was diminished at week 36 (between-group difference in BPI Interference score, −0.34; 95% CI, −0.72 to 0.04). A decrease in BPI Interference score greater than 1 point (minimal clinically important difference) occurred in 143 of 281 participants (50.9%) in the PCST group vs 108 of 295 participants (36.6%) in the usual care group at 12 weeks (odds ratio, 1.79; 95% CI, 1.28-2.49) and 142 of 258 participants (55.0%) in the PCST group vs 113 of 264 participants (42.8%) in the usual care group at 24 weeks (odds ratio, 1.59; 95% CI, 1.13-2.24). Favorable changes with PCST were also apparent for secondary outcomes of 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.

Conclusions and Relevance: In this randomized clinical trial of patients undergoing maintenance hemodialysis, PCST had benefits on pain interference and other pain-associated outcomes. 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 woowoo industry is spreading further, creeping deeper into medical practice and culture. Features all the hits we are used to, all the flaws of useless psychobehavioral research, where trying to convince people to answer differently on some questionnaires will sometimes lead to people slightly doing that.

Including a gushing sales pitch that incorrectly labels it a proper RCT, when the paper itself calls it a randomized clinical trial, which is such a common sleight-of-hand that it can be called a standard. About as clever as changing a contract after it was signed. All it takes is having zero shame in doing something obviously deceitful.

A growing industry focused entirely on make-believe, sucking up resources and attention away from useful research, sane-washing textbook pseudoscience. In this case as part of the NIH initiative to address the opioid crisis, which is a completely misguided use.

We can't frame our problem with so-called evidence-based medicine as contained in or around the medically-neglected conditions. This is clearly an industry-wide crisis that is getting worse with time. It just happens to harm us the most because unlike most medical conditions, this is all there is.

 

I wouldn’t be surprised in a couple years if they would be recommending CBT for pain as a substitute for anesthesia.

 

I can't find a solid number on how much this junk cost. Would be interesting as a comparison since it's comparable in size to the PACE trial, and I simply can't accept that such a trial really needed $8M.

 

As a former hemodialysis nurse, I can attest to the depression and fatigue and some pain in that population, most but not all.

Here "enrolled 160 patients receiving maintenance hemodialysis who had fatigue, pain, or depression showed improvements in patient-reported outcomes (PROs) with a stepped collaborative care intervention that included cognitive behavioral therapy.7 However, only a subset of the participants had chronic pain, and the intervention included components that might not be widely implementable in the typical outpatient dialysis setting."

bolding mine.

So, the patients on dialysis who had chronic pain in addition to the usual depression, fatigue and mild pain---this subset got no response from the intervention? It seems to point that way.

Again, psych-lite, not very bright.

 

As long as the psychosomaticists line up to be the subjects

they might want to take a few objective measures - I’m pretty sure the anaesthetists rely on that /those anyway if it’s in a theatre

and how keen are surgeons likely to be ?