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

  • Jodie A. TraftonEmail author
  • John T. Sorrell
  • Mark Holodniy
  • Heather Pierson
  • Percy Link
  • Ann Combs
  • Dennis Israelski


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.


Pain Intensity Pain Management Mental Health Outcome Brief Symptom Inventory Average Effect Size 
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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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Copyright information

© Springer Science+Business Media, LLC (outside the USA)  2011

Authors and Affiliations

  • Jodie A. Trafton
    • 1
    Email author
  • John T. Sorrell
    • 5
    • 6
  • Mark Holodniy
    • 3
    • 4
  • Heather Pierson
    • 1
    • 7
  • Percy Link
    • 1
    • 2
    • 8
  • Ann Combs
    • 1
    • 2
    • 9
  • Dennis Israelski
    • 4
    • 5
  1. 1.Center for Health Care EvaluationVA Palo Alto Healthcare System and Stanford University Medical SchoolMenlo ParkUSA
  2. 2.Palo Alto Institute for Research and EducationPalo AltoUSA
  3. 3.HIV Clinical Program and AIDS Research CenterVA Palo Alto Health Care SystemPalo AltoUSA
  4. 4.Division of Infectious Diseases, Department of MedicineStanford University School of MedicineStanfordUSA
  5. 5.San Mateo County, San Francisco Peninsula AIDS Research Center and San Mateo County AIDS ProgramSan MateoUSA
  6. 6.Department of Anesthesia, Division of Pain ManagementStanford UniversityRedwood CityUSA
  7. 7.Puget Sound HC SystemTacomaUSA
  8. 8.Department of Earth and Planetary ScienceUC BerkeleyBerkeleyUSA
  9. 9.SeattleUSA

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