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Pain interference significantly impacts the lives of patients with dialysis-dependent kidney failure. Recent research highlights the potential of nonpharmacologic interventions, such as pain coping skills training, to alleviate this burden.
The study underscores the significance of pain coping skills training as a nonpharmacologic intervention for reducing pain interference in dialysis patients.
A recent clinical trial, led by the National Institutes of Health, has demonstrated that pain coping skills training (PCST) can significantly reduce pain interference in individuals undergoing long-term dialysis for end-stage kidney disease. This cognitive behavioral intervention was shown to improve additional pain-related outcomes, including anxiety, depression, and overall quality of life, suggesting it as a potent complement or alternative to traditional pain medications. The trial involved 643 participants and revealed that 51% of the PCST group reported reduced pain interference after 12 weeks, highlighting the intervention's potential benefits over usual care. However, the effects diminished after the intervention ceased, indicating a need for ongoing reinforcement.
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Chronic pain is a prevalent issue among individuals with dialysis-dependent kidney failure, often remaining inadequately managed due to limited treatment options.
Dialysis patients often experience chronic pain that is poorly managed, leading to significant pain interference in their daily activities. Traditional treatments like opioids have limited efficacy and pose additional risks, especially in the context of kidney failure.
The study conducted by the NIH highlights this unmet need, emphasizing the limited pain management strategies currently available.
“Very few interventions have been shown to improve the quality of life for people with end-stage kidney disease being treated with dialysis,” said Dr. Paul Kimmel, program director at NIH's National Institute of Diabetes and Digestive and Kidney Diseases.
Pain Coping Skills Training (PCST) provides a nonpharmacologic approach to managing chronic pain in dialysis patients.
PCST stands out as a promising approach, focusing on cognitive and behavioral strategies to mitigate the psychological impact of chronic pain. It features virtual, one-on-one coaching sessions aiming to enhance self-efficacy and reduce anxiety and depression.
“This study is the largest randomized controlled trial to show that a nonpharmacologic pain intervention provides benefits to people with end-stage kidney disease being treated with dialysis,” noted by Dr. Laura M. Dember.
The intervention showed significant reductions at 12 weeks and maintained benefits throughout 24 weeks, showcasing the potential of PCST as an effective pain management strategy.
PCST leads to meaningful improvements in pain-related outcomes, including reduced pain interference and enhanced mental health.
At 12 weeks, 51% of participants in the PCST group reported reduced pain interference compared to 37% in the usual care group. This suggests a substantial impact of the intervention on patients' abilities to manage pain-related challenges.
By targeting anxiety, depression, and pain severity, PCST not only impacts physical symptoms but also contributes to overall mental health improvements. Researchers suggest that continual support may be necessary to sustain these benefits.
“Although the effect of the pain coping skills training on the overall cohort was modest, its acceptability and safety make it a valuable complement to pain medications,” said the study authors.
Ongoing reinforcement of PCST is necessary for sustained benefits, and future research should focus on broader implementation strategies.
The trial indicates that while PCST offers distinct benefits, its effects diminish without continued reinforcement. This poses a challenge for sustained patient care and indicates a need for integrated, long-term support methods.
Future research should explore ways to extend the benefits observed during the trial through ongoing, scalable interventions that can be seamlessly integrated into routine care for dialysis patients.
The researchers concluded, “Future work will focus on how to prolong the favorable effects of pain coping skills training and how to broadly implement this intervention in clinical practice.”
Dember, L., Hsu, J., & Mehrotra, R. (2024). Pain coping skills training for patients receiving hemodialysis: The HOPE Consortium randomized clinical trial. JAMA Internal Medicine, 184(6), 1234-1244. doi: 10.1001/jamainternmed.2024.7140
National Institutes of Health. (2024). Behavioral intervention decreases how much pain affects daily activities in people with dialysis-dependent kidney failure. Retrieved January 09, 2025, from https://www.nih.gov/news-events/news-releases/behavioral-intervention-decreases-how-much-pain-affects-daily-activities-people-dialysis-dependent-kidney-failure