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Outcomes Associated with a Cognitive-Behavioral Chronic Pain Management Program Implemented in Three Public HIV Primary Care Clinics

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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.

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Acknowledgements

We would like to thank Drs. Michael Clark, Lance McCracken, and Kevin Vowles for their assistance in predicting the clinical effects of the cognitive-behavioral therapy program provided in this study. The work described in this manuscript was supported by a Community Collaborative project grant (CR04-PAIRE-519) and a Community Collaborative HIV Research Center award (CH05-SMCHC-612) from the California HIV/AIDS Research Program and by the Health Services Research and Development Service, Department of Veterans Affairs. The opinions expressed are those of the authors and do not reflect the official positions of the Department of Veterans Affairs nor the California HIV/AIDS Research Program. The treatment manual, CD with relaxation exercises, and additional description of the program implementation are available upon request from the authors.

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Author notes

  1. Ann Combs BA

    Present address: , 1833 13th St. Apt 210, Seattle, WA, 98122, USA

Authors and Affiliations

  1. 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 A. Trafton PhD, Heather Pierson PhD, Percy Link MEng & Ann Combs BA

  2. Palo Alto Institute for Research and Education, P.O. Box V-38, Palo Alto, CA, 94304-0038, USA

    Percy Link MEng & Ann Combs BA

  3. HIV Clinical Program and AIDS Research Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304-1290, USA

    Mark Holodniy MD

  4. Division of Infectious Diseases, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive (Stanford Mail Code: 5107), Stanford, CA, 94305, USA

    Mark Holodniy MD & Dennis Israelski MD

  5. San Mateo County, San Francisco Peninsula AIDS Research Center and San Mateo County AIDS Program, 222 West 39th Avenue, San Mateo, CA, 94403, USA

    John T. Sorrell PhD & Dennis Israelski MD

  6. Department of Anesthesia, Division of Pain Management, Stanford University, 430 Broadway St, Pavilion C, MC: 6343, Redwood City, CA, 94063-3132, USA

    John T. Sorrell PhD

  7. Puget Sound HC System, 9600 Veterans Drive, Tacoma, WA, 98493, USA

    Heather Pierson PhD

  8. Department of Earth and Planetary Science, UC Berkeley, 301 McCone Hall, Berkeley, CA, 94720-4767, USA

    Percy Link MEng

Authors
  1. Jodie A. Trafton PhD
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  2. John T. Sorrell PhD
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  3. Mark Holodniy MD
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  4. Heather Pierson PhD
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  5. Ann Combs BA
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Corresponding author

Correspondence to Jodie A. Trafton PhD.

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Trafton, J.A., Sorrell, J.T., Holodniy, M. et al. Outcomes Associated with a Cognitive-Behavioral Chronic Pain Management Program Implemented in Three Public HIV Primary Care Clinics. J Behav Health Serv Res 39, 158–173 (2012). https://doi.org/10.1007/s11414-011-9254-y

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  • DOI: https://doi.org/10.1007/s11414-011-9254-y

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