title: Outcomes associated with a cognitive-behavioral chronic pain management program implemented in three public HIV primary care clinics.
abstract: In patients with HIV/AIDS, chronic pain is common and analgesics pose serious risks. Cognitive-behavioral therapies (CBT) provide an alternative. This study evaluated feasibility and impact of a CBT-based pain management program in three public primary care clinics for HIV patients. The program included a workbook and 12-weeks of group CBT sessions. HIV-positive patients with chronic moderate to severe pain were invited to participate in the program and were assessed at enrollment, 6, 12, and 24 weeks. Despite only moderate group attendance, program enrollment was associated with significant improvements in pain intensity, pain-related functioning, anxiety and acceptance, and mental health. At 24 weeks, effect sizes for pain outcomes were -0.83 for pain intensity and -0.43 for functioning. The pattern of change in outcomes was consistent with predictions based on cognitive-behavioral theory. Effects were observed at all clinics. Adding CBT-based pain management into primary care may provide important benefits for patients with HIV/AIDS.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Healthcare System and Stanford University Medical School, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Jodie.Trafton@va.gov
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Trafton
authors.forename: John T
authors.initials: JT
authors.lastname: Sorrell
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
authors.forename: Heather
authors.initials: H
authors.lastname: Pierson
authors.forename: Percy
authors.initials: P
authors.lastname: Link
authors.forename: Ann
authors.initials: A
authors.lastname: Combs
authors.forename: Dennis
authors.initials: D
authors.lastname: Israelski
mesh_terms: D001007:Anxiety / Q000209:etiology / Q000523:psychology; D059350:Chronic Pain / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008603:Mental Health; D017063:Outcome Assessment, Health Care; D059408:Pain Management; D010147:Pain Measurement; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors