ABQ Times

People undergoing hemodialysis for kidney failure often face chronic pain, which is challenging to manage with traditional treatments like opioids. A study published in JAMA Internal Medicine has shown that pain coping skills training (PCST) can significantly alleviate this suffering and enhance the quality of life for these patients.

Mark Unruh, MD, Chair of the UNM Department of Internal Medicine, noted the study's findings: "This study demonstrated that there was a small and significant benefit to the use of cognitive behavioral therapy (CBT) in the population of patients on hemodialysis with chronic pain." He emphasized the importance of these findings due to limited therapeutic options and poor outcomes associated with opioid use in this group.

The randomized controlled study involved 643 participants from 16 medical centers and 103 dialysis clinics within The HOPE Consortium. This ongoing multi-site study seeks new treatments for dialysis patients. In New Mexico, 22 participants, many Native American, were part of UNM's contribution to the research. "New Mexico played a large role in the trial," Unruh said. "We served as the primary outcomes measurement core and New Mexico had a supplement to recruit from rural clinics with a focus on our underrepresented populations."

Dialysis-related pain is influenced by multiple factors, including age-related conditions such as arthritis, diabetes, peripheral neuropathy, and back pain. Dialysis itself may contribute directly or indirectly through uremic toxins or needle procedures. Treating this pain is complicated by kidney failure; nonsteroidal anti-inflammatory agents are generally avoided, and opioids are not preferred due to renal clearance issues.

Participants were divided into two groups: one received PCST intervention while the other continued usual care. The PCST included 45-minute coaching sessions over phone or video for 12 weeks and another 12 weeks of daily automated interactive voice response sessions. These sessions covered topics like anxiety related to pain, stress management, sleep difficulties, CBT techniques, mindfulness practices, and experiential training aimed at boosting self-efficacy in using coping skills.

Unruh described it as "a recipe with 12 components," focusing on strategies like reframing thoughts and reducing catastrophizing through mindfulness meditation while addressing anxiety and depression.

The study revealed modest improvements in how much pain affected daily activities among those who received PCST. Unruh stated its clinical relevance: “The relevance would be that if I'm seeing someone in a clinic who has chronic pain rather than prescribing an opioid I could refer them to a psychologist who practices CBT.”

He highlighted how research like this can improve clinical care: “It is great to see these results in press and offer alternatives other than opioids to our patients on dialysis for treatment of chronic pain.”