1. The Combination of Tai Chi, Cognitive Behavioral Therapy and Motivational Text Messaging Improves Physical Function, Reduces Substance Use and Improves Pain in Older HIV-Infected Adults
JE Lake*, MC Reid, S Glasner Edwards, A Kuerbis, J Candelario, D Liao, L Tang and AA Moore for the STOP PAIN Study

2. Conflict of Interest
No conflicts of interest to declare.

3. Background and Design
Chronic pain is common among older HIV+ adults and contributes to substance use and reduced physical function.
Non-pharmacologic interventions to reduce pain, improve coping skills and/or improve physical function may reduce disability and improve quality of life for older HIV+ adults.
Pilot, randomized, 3-arm, 12-week trial of weekly combined cognitive behavioral therapy (CBT) + tai chi + motivational texting vs standard weekly support group vs no intervention in older HIV+ adults with chronic pain and substance use.

4. Methods
Study Population: HIV+, ≥50 years of age, chronic pain for ≥3 months on most days, substance use or use of prescription pain medications greater than prescribed in the last 3 months, able to participate in low-intensity exercise, have a cell phone that can receive text messages
Setting: APAIT, a community-based organization in Los Angeles, CA, USA
Outcomes and Assessments:
Pain: Brief Pain Inventory, Pain Self-Efficacy Scale, modified Roland-Morris Disability
Substance use: WHO ASSIST 3, 30-day Timeline Followback, Stages of Change
Readiness and Treatment Eagerness Scale (SOCRATES)
Physical function: Short Physical Performance Battery
Statistical Analysis: Intention-to-treat analyses of repeated measures at weeks 0, 8 and 12; within- and between-group changes were assessed by paired t-test/chi square test for continuous/categorical variables, respectively, with the exception of within-group changes in frequency of reduced physical function (compared with mixed effects model)

5. Results and Conclusions
Population:
-Median age 55, 84% non-white, 76% male/15% female/9% transgender female
-Median years pain 11, years with HIV 17, CD4 count 597, comorbidities 3
-60% alcohol or marijuana as preferred substance
-42% prescription pain med use (22% NSAIDS, 16% opioids, 7% neuropathic)
Substance Use Outcomes:
-The combined (EXP) and support group (cINT) interventions had significant
increases in % days abstinent from their preferred substance.
-EXP also reported an increased in # days abstinent from any substance.
-No changes in substance use outcomes among participants not receiving an
intervention (noINT).
Pain and Physical Function Outcomes:
-EXP participants reported significantly greater pain relief from medications.
-EXP participants also had improved physical function scores, and significantly
lower frequency of reduced physical function.
-No consistent changes in pain or physical function outcomes were observed for
cINT or noINT.

6. Thank you!
STOP PAIN participants and staff
Funders
Institutions