Becky Ham
February 4, 2003

Nearly half of 61 HIV-positive patients enrolled in psychotherapy sessions to relieve limb pain dropped out of the sessions before the end of therapy, suggesting that such an approach may have limited appeal, a new study concludes.

Patients who completed all sessions, on the other hand, experienced significantly reduced pain and reported less interference from pain when they carried out their daily routines, according to Susan Evans, Ph.D., of Cornell University and colleagues.

Despite receiving detailed information about the therapy and its expected outcomes at the start, "some individuals who dropped out of the study suggested that they were looking for medical management of their pain and did not see the relevance of 'talking' therapy," Evans and colleagues say.

The study was published in the January-February 2003 issue of Psychosomatics.

To compare the effects of two different types of psychotherapy on HIV-related pain, the researchers recruited 61 patients with HIV-related peripheral neuropathy, a condition that affects 30 percent of HIV-positive patients, causing numbness, tingling and burning sensations in the feet and limbs.

All of the patients in the study were taking antiretroviral medication, which can contribute to this type of pain. Most of the individuals were also taking some form of pain medication, but reported minimal relief of their pain.

Evans and colleagues assigned half of the patients six weeks of psychotherapy that emphasized personal coping skills and the other half to receive more supportive counseling psychotherapy.

Using a series of questionnaires, the researchers compared pain intensity and the effect of pain on daily life functions and mood before and after the six weeks of therapy. Each group experienced significant reductions in pain and some improvement in life functions like walking, sleeping and enjoyment of life. The coping skills group showed improvement in more life function categories than the supportive psychotherapy group.

However, 28 patients dropped out of the treatment before its completion and 64 percent of the dropouts attended only one session, making it difficult to determine the overall effectiveness of psychotherapy for HIV-related pain, according to the researchers.

"The significant dropout rate in this study suggests that the acceptability and feasibility of psychotherapeutic treatment for pain in HIV-positive patients are limited," the researchers say.

The study was funded by a grant from the National Institute of Mental Health.

---Health Behavior News Service