HOPE
Trial question
What is the role of pain coping skills training in patients undergoing maintenance hemodialysis and experiencing chronic pain?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
45.0% female
55.0% male
N = 643
643 patients (288 female, 355 male).
Inclusion criteria: adult patients undergoing maintenance hemodialysis and experiencing chronic pain.
Key exclusion criteria: substance use disorder; suicidal intent; substantial cognitive impairment; anticipated change in renal replacement modality within 6 months; life expectancy < 6 months.
Interventions
N=319 pain coping skills training (12 week of weekly remotely delivered coach-led sessions and daily interactive voice response sessions).
N=324 usual care (no trial-driven approach to management of pain).
Primary outcome
Reduction in Brief Pain Inventory Interference score at week 12
1.19 points
0.71 points
1.2 points
0.9 points
0.6 points
0.3 points
0.0 points
Pain coping skills
training
Usual
care
Significant
increase ▲
Significantly greater reduction in BPI Interference score at week 12 (1.19 points vs. 0.71 points; MD 0.49, 95% CI 0.12 to 0.85).
Secondary outcomes
Significantly greater reduction in BPI Interference score > 1 point at week 12 (50.9% vs. 36.6%; OR 1.79, 95% CI 1.28 to 2.49).
No significant difference in reduction in pain intensity at week 12 (0.86 points vs. 0.57 points; MD 0.27, 95% CI -0.06 to 0.61).
No significant difference in reduction in pain catastrophizing at week 12 (1.9 points vs. 1.1 points; MD 0.93, 95% CI -0.01 to 1.86).
Safety outcomes
No significant difference in adverse and serious adverse events.
Conclusion
In adult patients undergoing maintenance hemodialysis and experiencing chronic pain, pain coping skills training was superior to usual care with respect to reduction in BPI Interference score at week 12.
Reference
Laura M Dember, Jesse Y Hsu, Rajnish Mehrotra et al. Pain Coping Skills Training for Patients Receiving Hemodialysis: The HOPE Consortium Randomized Clinical Trial. JAMA Intern Med. 2024 Dec 30. Online ahead of print.
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