HIV
Clarissa Chan, PharmD
A study published in JAMA Internal Medicine on July 15, 2024, showed that self-management of chronic pain with the “Skills to Manage Pain” (STOMP) intervention may help patients with HIV.
The research highlights how combining behavioral strategies with peer support can significantly enhance pain management outcomes for people living with HIV. It may also set a new standard for nonpharmacologic pain management techniques beyond traditional pharmacologic treatments.
Evaluating STOMP efficacy
Researchers studied 278 patients over 3 years comparing two methods of delivering the STOMP program: Active participation in one-on-one and group sessions versus a passive approach of reading a STOMP manual. STOMP one-on-one covers a range of practical topics, including physical activity, weight loss, relaxation, sleep management, self-worth, and opioids. The topics are re-emphasized in group sessions with health educators and peers.
“The first five topics could help everyone in life, so it’s naturally presumed to help patients in pain,” said Mark Garofoli, PharmD, a clinical assistant professor at WVU School of Pharmacy, who was not part of the study.
The STOMP opioid medication session intervention provides education on opioid misuse, risk of overdose, and adverse effects, as well as exploring other medications and approaches used to manage pain, said Katie Fitzgerald Jones, PhD, a nurse scientist at the New England Geriatric Research Education and Clinical Center, and an author of the study.
Patients enrolled in the STOMP intervention who attended approximately six one-on-one and group sessions over 12 weeks yielded statistically better pain management scores than those simply receiving the manual, according to Garofoli. Brief Pain Inventory scores immediately after intervention were −1.25 points, and 3 months later were –0.62 points. “The improvement was evident immediately after the intervention and persisted 3 months later,” he said.
Garofoli also noted that an appreciable number of patients—approximately 25%—used prescription opioids as part of their pain management treatment plan and gained further pain reduction with education and use of the STOMP coping skills.
The study’s transition to remote delivery during the COVID-19 pandemic further highlighted the flexibility and effectiveness of digital interventions in pain management, Garofoli said.
Enhancing patient care holistically
The study’s findings underscore the need for peer support and pain self-management education as essential for patients coping with chronic pain.
“While the STOMP intervention was effective despite lower-than-anticipated adherence, we were also pleased to see it was effective despite pivoting to…phone delivery because of the pandemic,” said Fitzgerald Jones.
“Along with teaching patients about their medications, pharmacists are well positioned to promote pain self-management, so individuals can develop a collection of tools to cope with chronic pain that does not solely rely on pharmacologic approaches,” said Fitzgerald Jones. “Pharmacists can use the STOMP manual as a starting point to develop dialogue, often with motivational therapy techniques that develop rapport to make patient-specific pain goals and effectively promote behavioral change—such as managing stress, physical activity, weight loss.”
For example, the STOMP manual asks patients questions such as “what are the tools you use to manage your pain?” “What goals are you hoping to set this week?” “How will you meet these goals?” noted Fitzgerald Jones.
“STOMP is easily scalable since the staff delivering the pain self-management education are clinicians—like social workers, pharmacists, and health educators—who are already core staff in the HIV clinic,” Fitzgerald Jones said.
Study limitations
“The study is insightful as it’s the first peer-involved randomized controlled trial showing efficacy for self-management of pain,” said Candice Williams, MD, an anesthesiologist and pain management specialist, who was not part of the study.
However, she pointed out that some of the weaknesses of the study include its inability to blind the treatment/control groups to the intervention, its narrow scope in terms of only including patients with HIV, and a short follow up period of 3 months—which she said does not allow time to assess whether pain relief has true clinical efficacy.
While the nonpharmacologic STOMP intervention shows promise, more extensive studies are needed to confirm its efficacy and applicability across different patient populations, Williams said.
“Any intervention that is low risk and can improve chronic pain is much needed, as chronic pain and the opioid crisis are serious public health issues that require creative and innovative solutions,” said Williams. ■