A new clinical study has revealed promising results for dialysis patients suffering from chronic pain. U.S. Kidney doctors say these results suggest that behavioural training could offer a non-drug alternative to traditional pain management.
Chronic pain for kidney patients
Chronic pain is a common problem among people undergoing dialysis, often affecting their ability to carry out daily activities and significantly reducing their quality of life.
Certain pain medications are not appropriate for individuals with kidney failure, for example NSAIDs or very high dose aspirin. This means that prescribing options are limited to acetaminophen and opioids, these drugs are not always the best option for patients.Â
Putting pain coping skills to the testÂ
The study, conducted across 16 U.S. academic centres and 103 outpatient dialysis clinics, involved 643 participants receiving regular dialysis treatment. Led by Dr Laura Dember of the University of Pennsylvania and funded by the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), the project focused on evaluating the effectiveness of a psychological approach known as Pain Coping Skills Training (PCST).
The programme uses cognitive behavioural therapy techniques to help patients develop better pain and stress management strategies.
Participants were randomly divided into two groups. One of the groups received the usual care, including administration of opioid-based pain medication where appropriate. The other underwent PCST in addition to their regular pain meds. PCST consisted of 12 weekly sessions led by trained coaches and 12 weeks of follow-up through daily automated calls.
Pain gains
The sessions covered various approaches aimed at reducing pain-related anxiety, improving sleep, as well as building confidence in handling pain. After 12 weeks, the PCST group showed significant improvement compared to the usual care group.
The primary benefit was a reduction in how much pain interfered with daily activities, as measured by a standard pain questionnaire. Around half of the participants in the PCST group reported noticeable pain relief, while only 36% of those receiving standard care experienced similar improvement.
Furthermore, the researchers observed improvements in secondary outcomes, such as pain intensity, quality of life, depression, and anxiety. These benefits were most evident during the first 24 weeks but appeared to diminish slightly by the end of the 36-week study period. Nevertheless, for many participants, the psychological support provided by PCST had a lasting positive impact.
Pain relief for patients who can’t tolerate opioids
‘Pain management remains one of the most difficult aspects of care for dialysis patients,’ said Dr Dember. ‘There are limited medication options for these patients due to their kidney condition, making non-pharmacological solutions like PCST a vital area of research.’
The findings, published in JAMA Internal Medicine, underscore the importance of non-drug interventions for individuals undergoing dialysis. Pain medications, particularly opioids, carry significant hazards for these patients, including potential side effects and dependency issues. Therefore, a safer, low-risk approach like PCST could play a crucial role in improving their overall well-being in the long run.
Clinically meaningful results for dialyisis patients with chronic pain
Could talk therapy take the edge of chronic pain for dialysis patients? The study’s large and diverse participant pool adds to the credibility of the results. Those who took part ranged in age, ethnicity, and clinical backgrounds, making the findings applicable to a broad spectrum of dialysis patients. The researchers also noted that adherence to the programme was high, with most participants completing the sessions, indicating its relevance to real-world settings.
While the improvements seen in the PCST group were described as modest, they were clinically meaningful. Experts believe that even small gains can make a big difference in the lives of dialysis patients, who often face multiple health challenges and a heavy treatment burden.
As researchers call for further studies to assess the long-term benefits and cost effectiveness of PCST, this trial offers hope for thousands of dialysis patients across the country. With wider implementation, PCST could become a standard part of comprehensive care for those living with kidney failure.
ReferenceÂ
1. Dember, L. M., Hsu, J. Y., Mehrotra, R., Cavanaugh, K. L., Kalim, S., Charytan, D. M., … & Cukor, D. (2024). Pain coping skills training for patients receiving hemodialysis: The HOPE Consortium randomized clinical trial. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.7140
2. National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Helping to End Addiction Long-term Initiative (HEAL): Clinical trials for pain management. Retrieved from https://www.niddk.nih.gov
3. Keefe, F. J., Porter, L. S., Somers, T. J., Shelby, R. A., & Wren, A. V. (2020). Psychosocial interventions for managing pain in older adults: Evidence and recommendations. Pain Medicine, 21(1), 117–125. https://doi.org/10.1093/pm/pnz172
4. Morasco, B. J., & Krebs, E. E. (2019). Nonpharmacologic approaches to pain management in kidney disease. Clinical Journal of the American Society of Nephrology, 14(4), 618–626. https://doi.org/10.2215/CJN.12221018
5. Johansen, K. L., & Kurella-Tamura, M. (2018). Chronic pain in hemodialysis patients: Clinical challenges and treatment strategies. Seminars in Dialysis, 31(5), 493–498. https://doi.org/10.1111/sdi.12700
6. Charytan, D. M., & Unruh, M. (2019). The burden of chronic pain in patients with kidney failure: A call for improved care. Kidney International Reports, 4(10), 1301–1308. https://doi.org/10.1016/j.ekir.2019.08.014
7. Mehrotra, R., & Wetmore, J. B. (2020). The role of cognitive-behavioural therapy in the management of dialysis-related pain. Nephrology Dialysis Transplantation, 35(7), 1172–1178. https://doi.org/10.1093/ndt/gfz236
8. Steel, J. L., & White, P. L. (2022). Improving quality of life for dialysis patients through psychological support: Current evidence and future directions. Palliative Medicine Reports, 3(1), 45–52. https://doi.org/10.1089/pmr.2021.0043
9. Pain Medicines (Analgesics) | National Kidney Foundation. Accessed January 10, 2025. https://www.kidney.org/kidney-topics/pain-medicines-analgesics
A new clinical study has revealed promising results for dialysis patients suffering from chronic pain. U.S. Kidney doctors say these results suggest that behavioural training could offer a non-drug alternative to traditional pain management. Chronic pain is a common problem among people undergoing dialysis, often affecting their ability to carry out daily activities and significantly reducing their quality of life. Certain pain medications are not appropriate for individuals with kidney failure, for example NSAIDs or very high dose aspirin. This means that prescribing options are limited to acetaminophen and opioids, these drugs are not always the best option for patients. The study, conducted across 16 U.S. academic centres and 103 outpatient dialysis clinics, involved 643 participants receiving regular dialysis treatment. Led by Dr Laura Dember of the University of Pennsylvania and funded by the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), the project focused on evaluating the effectiveness of a psychological approach known as Pain Coping Skills Training (PCST). The programme uses cognitive behavioural therapy techniques to help patients develop better pain and stress management strategies. Participants were randomly divided into two groups. One of the groups received the usual care, including administration of opioid-based pain medication where appropriate. The other underwent PCST in addition to their regular pain meds. PCST consisted of 12 weekly sessions led by trained coaches and 12 weeks of follow-up through daily automated calls. The sessions covered various approaches aimed at reducing pain-related anxiety, improving sleep, as well as building confidence in handling pain. After 12 weeks, the PCST group showed significant improvement compared to the usual care group. The primary benefit was a reduction in how much pain interfered with daily activities, as measured by a standard pain questionnaire. Around half of the participants in the PCST group reported noticeable pain relief, while only 36% of those receiving standard care experienced similar improvement. Furthermore, the researchers observed improvements in secondary outcomes, such as pain intensity, quality of life, depression, and anxiety. These benefits were most evident during the first 24 weeks but appeared to diminish slightly by the end of the 36-week study period. Nevertheless, for many participants, the psychological support provided by PCST had a lasting positive impact. ‘Pain management remains one of the most difficult aspects of care for dialysis patients,’ said Dr Dember. ‘There are limited medication options for these patients due to their kidney condition, making non-pharmacological solutions like PCST a vital area of research.’ The findings, published in JAMA Internal Medicine, underscore the importance of non-drug interventions for individuals undergoing dialysis. Pain medications, particularly opioids, carry significant hazards for these patients, including potential side effects and dependency issues. Therefore, a safer, low-risk approach like PCST could play a crucial role in improving their overall well-being in the long run. Could talk therapy take the edge of chronic pain for dialysis patients? The study’s large and diverse participant pool adds to the credibility of the results. Those who took part ranged in age, ethnicity, and clinical backgrounds, making the findings applicable to a broad spectrum of dialysis patients. The researchers also noted that adherence to the programme was high, with most participants completing the sessions, indicating its relevance to real-world settings. While the improvements seen in the PCST group were described as modest, they were clinically meaningful. Experts believe that even small gains can make a big difference in the lives of dialysis patients, who often face multiple health challenges and a heavy treatment burden. As researchers call for further studies to assess the long-term benefits and cost effectiveness of PCST, this trial offers hope for thousands of dialysis patients across the country. With wider implementation, PCST could become a standard part of comprehensive care for those living with kidney failure. 1. Dember, L. M., Hsu, J. Y., Mehrotra, R., Cavanaugh, K. L., Kalim, S., Charytan, D. M., … & Cukor, D. (2024). Pain coping skills training for patients receiving hemodialysis: The HOPE Consortium randomized clinical trial. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.7140 2. National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Helping to End Addiction Long-term Initiative (HEAL): Clinical trials for pain management. Retrieved from https://www.niddk.nih.gov 3. Keefe, F. J., Porter, L. S., Somers, T. J., Shelby, R. A., & Wren, A. V. (2020). Psychosocial interventions for managing pain in older adults: Evidence and recommendations. Pain Medicine, 21(1), 117–125. https://doi.org/10.1093/pm/pnz172 4. Morasco, B. J., & Krebs, E. E. (2019). Nonpharmacologic approaches to pain management in kidney disease. Clinical Journal of the American Society of Nephrology, 14(4), 618–626. https://doi.org/10.2215/CJN.12221018 5. Johansen, K. L., & Kurella-Tamura, M. (2018). Chronic pain in hemodialysis patients: Clinical challenges and treatment strategies. Seminars in Dialysis, 31(5), 493–498. https://doi.org/10.1111/sdi.12700 6. Charytan, D. M., & Unruh, M. (2019). The burden of chronic pain in patients with kidney failure: A call for improved care. Kidney International Reports, 4(10), 1301–1308. https://doi.org/10.1016/j.ekir.2019.08.014 7. Mehrotra, R., & Wetmore, J. B. (2020). The role of cognitive-behavioural therapy in the management of dialysis-related pain. Nephrology Dialysis Transplantation, 35(7), 1172–1178. https://doi.org/10.1093/ndt/gfz236 8. Steel, J. L., & White, P. L. (2022). Improving quality of life for dialysis patients through psychological support: Current evidence and future directions. Palliative Medicine Reports, 3(1), 45–52. https://doi.org/10.1089/pmr.2021.0043 9. Pain Medicines (Analgesics) | National Kidney Foundation. Accessed January 10, 2025. https://www.kidney.org/kidney-topics/pain-medicines-analgesics
Chronic pain for kidney patients
Putting pain coping skills to the testÂ
Pain gains
Pain relief for patients who can’t tolerate opioids
Clinically meaningful results for dialyisis patients with chronic pain
ReferenceÂ
