Trajectories of Pain Impact and Pain Self-Efficacy in People with HIV and Chronic Pain: Extending Findings from the Skills TO Manage Pain (STOMP) Randomized Clinical Trial

Abstract

Background: People with HIV (PWH) frequently experience chronic pain, which negatively impacts their health and functioning. To improve health outcomes, we need effective interventions for HIV-related chronic pain. Skills TO Manage Pain (STOMP), a novel pain self-management intervention tailored for PWH and chronic pain, has demonstrated efficacy in reducing pain impact (measured by the Brief Pain Inventory) and improving pain self-efficacy immediately after a 12-week intervention and three months later.

Setting: We conducted this study at two Center for AIDS Research Network of Integrated Clinical Systems clinics.

Methods: We evaluated the efficacy of STOMP across 12 months by comparing trajectories of pain impact and pain self-efficacy among 244 adults (49% female, Mage = 53.62) randomized equally to the STOMP intervention or an Enhanced Usual Care (EUC) control condition. We also examined whether pain self-efficacy is a mechanism of change that helps explain how STOMP affects pain impact.

Results: Over 12 months, individuals who participated in STOMP reported lower pain impact and higher pain self-efficacy than those in EUC. Over time, the difference in pain impact attenuated slightly between the two groups but remained statistically significant. Pain self-efficacy remained significantly higher for the STOMP group. Individuals in STOMP showed greater improvements in their confidence to manage pain than those in EUC, resulting in less severe pain and reduced interference in daily life.

Conclusions: STOMP is an efficacious chronic pain intervention for PWH, improving pain outcomes one year later. Future research should evaluate mechanisms of change and best practices for implementing STOMP.

Keywords: HIV; chronic pain; self-efficacy; self-management.