Engagement in a Tailored Pain Coping Skills Training for Patients with Chronic Pain Receiving Maintenance Hemodialysis for Kidney Failure

Pain Coping Skills Training (PCST) is a first-line non-pharmacological treatment for pain, yet challenges unique to patients with kidney failure treated by hemodialysis (HD) may impact their capacity to engage in standard PCST. We describe PCST adaptations that address these challenges as part of an ongoing multi-center clinical trial (HOPE study) testing the effectiveness of telehealth PCST compared to usual care for reducing pain interference and opioid use in patients treated with HD. Prior to enrollment, the intervention protocol was adapted from standard PCST with input from patient representatives on the research team. PCST adaptations were based on unique considerations for HD patients (e.g., treatment demands, frequent hospitalizations, unique pain complaints, diverse socioeconomic circumstances and health literacy levels). Patients with chronic pain were recruited from 148 dialysis facilities across the United States. Participants randomized to PCST received 12 weekly, 45-minute sessions via telemedicine with one of six trained masters-level PCST coaches. PCST adaptations included 1) providing flexible session options (e.g. video or audio only; located at dialysis or elsewhere; scheduled day/time 2) pain management skills specific to HD and kidney failure (e.g. acute needle assertion pain); 3) adding sleep and anxiety management skills, and; 4) incorporating Motivational Interviewing to facilitate desired opioid reduction and other individual life goals affected by pain and HD. To date, 109 participants have been randomized to PCST. Of 83 participants who reached week 12 (n=78) or withdrew (n=5), the mean number of sessions completed was 10.9, with 91.6% (n=76) completing the minimum target of >8 sessions. Of 1002 sessions completed, 68.7% were completed within the target of 5-9 days from the previous session (approximately weekly). Hospitalization or feeling sick accounted for 29.7% of missed sessions. Patients treated with HD demonstrate high levels of engagement with an adapted PCST intervention that addresses HD-specific challenges. Grant support from National Institutes of Health - National Institute of Diabetes and Digestive and Kidney Diseases (awards U01DK123786, U01DK123787, U01DK123812, U01DK123813, U01DK123814, U01DK123816, U01DK123817, U01DK123818, U01DK123821). Pain Coping Skills Training (PCST) is a first-line non-pharmacological treatment for pain, yet challenges unique to patients with kidney failure treated by hemodialysis (HD) may impact their capacity to engage in standard PCST. We describe PCST adaptations that address these challenges as part of an ongoing multi-center clinical trial (HOPE study) testing the effectiveness of telehealth PCST compared to usual care for reducing pain interference and opioid use in patients treated with HD. Prior to enrollment, the intervention protocol was adapted from standard PCST with input from patient representatives on the research team. PCST adaptations were based on unique considerations for HD patients (e.g., treatment demands, frequent hospitalizations, unique pain complaints, diverse socioeconomic circumstances and health literacy levels). Patients with chronic pain were recruited from 148 dialysis facilities across the United States. Participants randomized to PCST received 12 weekly, 45-minute sessions via telemedicine with one of six trained masters-level PCST coaches. PCST adaptations included 1) providing flexible session options (e.g. video or audio only; located at dialysis or elsewhere; scheduled day/time 2) pain management skills specific to HD and kidney failure (e.g. acute needle assertion pain); 3) adding sleep and anxiety management skills, and; 4) incorporating Motivational Interviewing to facilitate desired opioid reduction and other individual life goals affected by pain and HD. To date, 109 participants have been randomized to PCST. Of 83 participants who reached week 12 (n=78) or withdrew (n=5), the mean number of sessions completed was 10.9, with 91.6% (n=76) completing the minimum target of >8 sessions. Of 1002 sessions completed, 68.7% were completed within the target of 5-9 days from the previous session (approximately weekly). Hospitalization or feeling sick accounted for 29.7% of missed sessions. Patients treated with HD demonstrate high levels of engagement with an adapted PCST intervention that addresses HD-specific challenges. Grant support from National Institutes of Health - National Institute of Diabetes and Digestive and Kidney Diseases (awards U01DK123786, U01DK123787, U01DK123812, U01DK123813, U01DK123814, U01DK123816, U01DK123817, U01DK123818, U01DK123821).