Areas to Refine in the Skills to Manage Pain (STOMP) Trial

Abstract

To the Editor We appreciate the comprehensive and insightful study by Jones et al 1 published recently in JAMA Internal Medicine. This randomized clinical trial highlighted the potential of the Skills to Manage Pain (STOMP) intervention in alleviating chronic pain among patients with HIV. We commend the authors for their contributions to this vital research and would like to discuss areas that warrant cautious interpretation and further exploration.First, the study only involved 6 one-on-one sessions, primarily with older patients (a mean [SD] age of 53.5 [10.0] years). 1 Educating older adults about health is always challenging, even for experienced health educators, with online interventions further compounding this challenge. To improve the effectiveness of future interventions, we recommend involving social workers focused on older adult populations and health educators in the intervention implementation. Additionally, staff and peer interventionists should be trained in geriatric education to enhance the adaptability and effectiveness of the intervention.Second, participant adherence to the intervention was relatively low, with many not completing all scheduled sessions. 1 On average, participants attended fewer than half of the group and 1-on-1 sessions. Although multiple imputation methods are appropriate for handling missing data, investigating the reasons for low adherence is essential to improve engagement in similar studies. In-depth interviews could be used to explore why patients did not complete all sessions. 2 Third, the study provided a detailed analysis across different subgroups, such as gender, race, and pain location. 1 However, we suggest including subgroup analyses based on education level, 3 psychological status, social support, 4 and economic status. 5 This will help gain a more comprehensive understanding of the STOMP intervention's effectiveness, allowing for more targeted adjustments to the intervention strategies.This study highlighted the vital role of health educators in improving chronic pain management for patients with HIV. 1