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Slow and Steady But Not Related to HIV Stigma: Physical Activity in South Africans Living with HIV and Chronic Pain. AIDS Behav 2022; 27:1950-1961. [PMID: 36436140 DOI: 10.1007/s10461-022-03928-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/28/2022]
Abstract
HIV stigma may influence physical activity in people living with HIV (PLWH) and chronic pain. We prospectively examined the relationship between stigma, activity and chronic pain in a convenience sample of PLWH initiating antiretroviral therapy in an inner-city clinic in Johannesburg, South Africa. Participants wore accelerometers to measure daily duration and intensity of activity for 2 weeks. Stigma was assessed with the Revised HIV Stigma Scale. Participants [n = 81, 89% female, age mean (SD) 42 (8)] were active for a median of 7 h daily (IQR 5.2, 9.2), but at very low intensity, equivalent to a slow walk [median (IQR): 0.39 m s-1 (0.33, 0.50)]. Duration and intensity of activity was not associated with stigma, even after controlling for age, self-assessed wealth, pain intensity and willingness to engage in physical activity (p-values > 0.05). As stigma did not associate with greater activity, drivers of sustained activity in South African PLWH remain unclear.
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Charumbira MY, Berner K, Louw QA. Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315636. [PMID: 36497710 PMCID: PMC9735592 DOI: 10.3390/ijerph192315636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 05/05/2023]
Abstract
A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aimed to systematically identify and map the most common functioning problems associated with health conditions that contribute most to disability in South Africa using the International Classification of Functioning, Disability and Health (ICF) framework. Peer-reviewed evidence published from January 2006 to December 2021 was systematically searched from five databases. Some 268 studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African adults (>18 years) related to 10 health conditions were included. A total of 130 different functioning problems were mapped to the ICF. The most prevalent problems (top 20) were related to mobility, pain, and mental health but spanned across several ICF domains and were mostly in patients at primary care. The high prevalence and wide range of functioning problems may be particularly burdensome on an already strained primary health care (PHC) system. This points towards targeted planning of innovative strategies towards strengthening rehabilitation service delivery at primary care to address these complexities where there is an inadequate rehabilitation workforce.
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Cohen SP, Wang EJ, Doshi TL, Vase L, Cawcutt KA, Tontisirin N. Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies. BMJ MEDICINE 2022; 1:e000108. [PMID: 36936554 PMCID: PMC10012866 DOI: 10.1136/bmjmed-2021-000108] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/10/2022] [Indexed: 12/20/2022]
Abstract
Throughout human history, infection has been the leading cause of morbidity and mortality, with pain being one of the cardinal warning signs. However, in a substantial percentage of cases, pain can persist after resolution of acute illness, manifesting as neuropathic, nociplastic (eg, fibromyalgia, irritable bowel syndrome), or nociceptive pain. Mechanisms by which acute infectious pain becomes chronic are variable and can include immunological phenomena (eg, bystander activation, molecular mimicry), direct microbe invasion, central sensitization from physical or psychological triggers, and complications from treatment. Microbes resulting in a high incidence of chronic pain include bacteria such as the Borrelia species and Mycobacterium leprae, as well as viruses such as HIV, SARS-CoV-2 and herpeses. Emerging evidence also supports an infectious cause in a subset of patients with discogenic low back pain and inflammatory bowel disease. Although antimicrobial treatment might have a role in treating chronic pain states that involve active infectious inflammatory processes, their use in chronic pain conditions resulting from autoimmune mechanisms, central sensitization and irrevocable tissue (eg, arthropathy, vasculitis) or nerve injury, are likely to cause more harm than benefit. This review focuses on the relation between infection and chronic pain, with an emphasis on common viral and bacterial causes.
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tina L Doshi
- Departments of Anesthesiology & Critical Care Medicine and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lene Vase
- Department of Psychology, Aarhus University Hospital, Aarhus, Denmark
| | - Kelly A Cawcutt
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nuj Tontisirin
- Department of Anaesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, Mahidol University, Bangkok, Thailand
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Marsh SE, Truter I. Improving health-related quality of life instrument translation into South African languages. S Afr Fam Pract (2004) 2021; 63:e1-e11. [PMID: 34797093 PMCID: PMC8603070 DOI: 10.4102/safp.v63i1.5361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background Most health-related quality of life (HRQoL) instruments have been created in English, which can influence their reliability and validity in non-English speaking populations. This study assessed the translation methodology of HRQoL instruments that have been used and translated into South African languages and which could be applied in cost-utility analyses (CUAs). Methods A 2019 systematic review was updated with searches conducted in Medline, the Web of ScienceTM (WoSTM) Core Collection and the South African SciELO collection via the WoSTM Platform. Additional searches in Sabinet’s African Journals database and on instrument developers’ webpages were performed. Only HRQoL instruments suitable for CUAs were included. Articles reporting at least one element of the translation methods were included. Established good practice principles were used to evaluate the translation methodology. Results Within the 39 publications identified, a dozen translated instruments have been used in South Africa. All instruments used were translated from English and none had originally been created in South Africa. Instrument developers’ translations were used more than study investigators’ translations. Almost all instrument developer versions met the full translation criteria. No investigator translated instrument met the full translation criteria primarily because recommendations on forward and back translations were not followed. However, this analysis was hampered by a lack of methodological reporting details. The most used instruments, which also had the most translated versions available, were the EQ-5D-3L, SF-36 version 2 and EORTC QLQ-C30. Conclusion Instrument developers’ translations more often met recommended translation methodology compared with investigators’ versions. The EQ-5D-3L may be best suited for South African economic evaluations and for use in clinical practice, but further work may be needed.
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Affiliation(s)
- Sophia E Marsh
- Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Gqeberha.
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Abstract
Painful distal symmetrical polyneuropathy is common in HIV and is associated with reduced quality of life. Research has not explored the experience of neuropathic pain in people with HIV from a person-centred perspective. Therefore, a qualitative interview study was conducted to more deeply understand the experience and impact of neuropathic pain in this population. Semistructured interviews were conducted with 26 people with HIV and peripheral neuropathic pain symptoms. Interviews explored the impact of pain and participants' pain management strategies. Interviews were transcribed verbatim and analysed using thematic analysis. Four themes and 11 subthemes were identified. Theme 1 reflects the complex characterisation of neuropathic pain, including the perceived unusual nature of this pain and diagnostic uncertainty. Theme 2 centred on the interconnected impacts of pain on mood and functioning and includes how pain disrupts relationships and threatens social inclusion. Theme 3 reflects the struggle for pain relief, including participants' attempts to "exhaust all options" and limited success in finding lasting relief. The final theme describes how pain management is complicated by living with HIV; this theme includes the influence of HIV stigma on pain communication and pain as an unwanted reminder of HIV. These data support the relevance of investigating and targeting psychosocial factors to manage neuropathic pain in HIV.
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Gao N, Guo Y, Wang W. Acupuncture for HIV-associated distal symmetric peripheral neuropathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25140. [PMID: 33725916 PMCID: PMC7969230 DOI: 10.1097/md.0000000000025140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated distal symmetric peripheral neuropathy (DSPN) is one of the most frequent neurological complications of HIV infection, and causes pain and dysaesthesias in millions globally. Many individuals with this infection report using acupuncture to manage their symptoms, but evidence supporting the use of acupuncture is limited. This systematic review will assess the effectiveness and safety of acupuncture for patients with HIV-associated DSPN. METHODS Databases including MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Scopus, Web of science, AMED (Allied and Complementary Medicine), the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, Wanfang Database, VIP Database and clinical trials registers (the WHO International Clinical Trials Registry Platform portal and www.ClinicalTrials.gov) will be electronically searched from inception to December 1, 2020. All randomized controlled trials in English or Chinese without restriction on publication status will be included. Selection of studies, extraction of data, and assessment of studies quality will be independently performed by 2 reviewers. The primary outcome measure will be the change in pain intensity assessed by validated scales. Secondary outcomes include change in neurologic summary scores, quality of life, physical function evaluated by admitted tools, and adverse events related to acupuncture reported in the included trials. If possible, a meta-analysis will be conducted to provide an estimate of the pooled treatment effect using Review Manager 5.3 statistical software. Otherwise, qualitative descriptive analysis will be given. The results will be presented as the risk ratio for binary data and the mean difference (MD) or standardized MD for continuous data. RESULTS The results of the systematic review will be disseminated via publication in a peer-reviewed journal and presented at a relevant conference. CONCLUSION This review will be the first review entirely focused on assessing the effectiveness and safety of acupuncture for HIV-associated DSPN. PROSPERO REGISTRATION NUMBER CRD42020210994.
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Scott W, Badenoch J, Garcia Calderon Mendoza Del Solar M, Brown DA, Kemp H, McCracken LM, C de C Williams A, Rice ASC. Acceptability of psychologically-based pain management and online delivery for people living with HIV and chronic neuropathic pain: a qualitative study. Scand J Pain 2021; 21:296-307. [PMID: 33544549 DOI: 10.1515/sjpain-2020-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Chronic neuropathic pain is common in people living with HIV. Psychological treatments can improve quality of life for people with chronic pain in general, and online delivery can increase access to these treatments. However, the acceptability of psychological treatment and online delivery have not been investigated in-depth in people living with HIV and chronic neuropathic pain. Therefore, a qualitative study was undertaken to explore views about a psychological treatment for pain management in this population and to investigate the acceptability of online treatment delivery. METHODS Qualitative interviews were conducted and analysed using inductive thematic analysis, adopting a critical realist perspective. Twenty-six people living with HIV and chronic neuropathic pain completed semi-structured interviews. Their views about a psychological treatment for pain management and online delivery were explored in-depth. RESULTS Three themes and 12 subthemes were identified. Theme one represents a desire for a broader approach to pain management, including not wanting to take more pills and having multidimensional goals that were not just focussed on pain relief. Theme two includes barriers to online psychologically-based pain management, including concerns about using the Internet and confidentiality. Theme three describes treatment facilitators, including accessibility, therapist support, social connection, and experiencing success. CONCLUSIONS A psychological treatment for chronic neuropathic pain management appears acceptable for people living with HIV. Therapist-supported online delivery of cognitive-behavioural pain management may be acceptable for people living with HIV given appropriate development of the treatment to address identified barriers to engagement. These data can inform developments to enhance engagement in online psychologically-informed pain management in people living with HIV and more broadly in remote delivery of psychological treatments.
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Affiliation(s)
- Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Badenoch
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Harriet Kemp
- Department of Surgery & Cancer, Faculty of Medicine, Pain Research Group, Imperial College London, London, UK
| | | | - Amanda C de C Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Andrew S C Rice
- Department of Surgery & Cancer, Faculty of Medicine, Pain Research Group, Imperial College London, London, UK
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Kietrys DM, Parrott JS, Galantino ML, Davis T, Levin T, O'Brien KK. Self-Reported Disability in Persons With HIV-Related Neuropathy Is Mediated by Pain Interference and Depression. Phys Ther 2020; 100:2174-2185. [PMID: 32914180 DOI: 10.1093/ptj/pzaa161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to compare disability in people with HIV and peripheral neuropathy with those without neuropathy and explore how neuropathy and other relevant factors are associated with disability. METHODS In this cross-sectional study, participants completed the Brief pain inventory, Beck Depression Inventory II, World Health Organization Disability Assessment Schedule (WHODAS 2.0), and a health and demographic questionnaire. Additional data were extracted from the medical record. A raw score of ≥1 on the Subjective Peripheral Neuropathy Screen questions about lower extremity numbness or paresthesia was used to identify peripheral neuropathy. Predictors of disability (as determined by association with World Health Organization Disability Assessment Schedule 2.0 scores) were evaluated bivariately and in a multivariable model. Path modeling was used to identify a parsimonious model to elucidate the mediated effects of peripheral neuropathy on disability. RESULTS Participants with peripheral neuropathy had more depression symptoms, more pain (severity and interference), and higher disability scores compared with participants without neuropathy. The relationship between neuropathy and disability was mediated by pain interference and depression (standardized root mean residual = .056). CONCLUSION In this sample of people with HIV, those with lower extremity peripheral neuropathy reported more severe disability, worse pain, and more depression symptoms than those without neuropathy. The relationship between peripheral neuropathy and disability may be mediated though pain interference and depression. IMPACT Distal sensory polyneuropathy is a common comorbidity experienced by people living with HIV and frequently causes pain. This study can help providers direct care toward lessening disability experienced among people with HIV and peripheral neuropathy by targeting interventions for treatment of pain and depression. LAY SUMMARY People living with HIV may experience disabling painful neuropathy. Treatment for pain and depression may help reduce the disability associated with painful neuropathy.
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Affiliation(s)
- David M Kietrys
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, 200 College Dr, Jefferson Hall #308, Blackwood, NJ 08012 (USA)
| | - James Scott Parrott
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers, The State University of New Jersey
| | - Mary Lou Galantino
- Physical Therapy Program, School of Health Sciences, Stockton University, Galloway, New Jersey; Family Medicine and Community Health, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania; and University of Witwatersrand, Johannesburg, South Africa
| | - Tracy Davis
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers, The State University of New Jersey
| | - Todd Levin
- School of Osteopathic Medicine, Rowan University, Stratford, New Jersey; and Jefferson Health, Voorhees, New Jersey
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto; and Rehabilitation Sciences Institute, University of Toronto
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Chai PR, Gale JY, Patton ME, Schwartz E, Jambaulikar GD, Wade Taylor S, Edwards RR, Boyer EW, Schreiber KL. The Impact of Music on Nociceptive Processing. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:3047-3054. [PMID: 32337605 PMCID: PMC7685689 DOI: 10.1093/pm/pnaa070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Music has been shown to modulate pain, although the impact of music on specific aspects of nociceptive processing is less well understood. Using quantitative sensory testing (QST), we assessed the impact of a novel music app on specific aspects of nociceptive processing. DESIGN Within-subjects paired comparison of pain processing in control vs music condition. SETTING Human psychophysical laboratory. SUBJECTS Sixty healthy adult volunteers. METHODS Subjects were assessed for baseline anxiety, depression, and catastrophizing using validated questionnaires. QSTs measured included 1) pain threshold and tolerance to deep muscle pressure, 2) pain with mechanical pinprick, 3) temporal summation of pain (TSP) with a repeated pain stimulus, and 4) conditioned pain modulation (CPM) with a second painful stimulus. QSTs were performed in the absence and presence of music delivered through a music app. RESULTS We found an increase in pressure pain thresholds in both the forearm (P = 0.007) and trapezius (P = 0.002) with music, as well as a decrease in the amount of pinprick pain (P < 0.001) and TSP (P = 0.01) with music. Interestingly, CPM was also significantly diminished (P < 0.001) in the music condition. No significant difference in cold pain, anxiety, or situational catastrophizing was observed with music. Higher baseline pain catastrophizing scores were associated with less music-induced pressure pain reduction. CONCLUSIONS Several measures of mechanical pain sensitivity were reduced with music. TSP, a measure of central sensitization, also decreased with music, but CPM, a measure of descending modulation of pain, was not further augmented by music.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women’s Hospital
- The Fenway Institute
| | - Jasmine Y Gale
- Department of Emergency Medicine, Brigham and Women’s Hospital
- Tufts University School of Medicine
| | - Megan E Patton
- Department of Anesthesiology, Brigham and Women’s Hospital
| | - Emily Schwartz
- Department of Anesthesiology, Brigham and Women’s Hospital
| | | | - S Wade Taylor
- The Fenway Institute
- Boston University, Boston, Massachusetts, USA
| | | | - Edward W Boyer
- Department of Emergency Medicine, Brigham and Women’s Hospital
- The Fenway Institute
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Basheer A, Kirubakaran R, Tan K, Vishnu VY, Fialho D. Disease-modifying therapy for HIV-related distal symmetrical polyneuropathy (including antiretroviral toxic neuropathy). Hippokratia 2020. [DOI: 10.1002/14651858.cd013716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Aneesh Basheer
- Department of Medicine; Pondicherry Institute of Medical Sciences; Pondicherry India
| | - Richard Kirubakaran
- Cochrane South Asia, Prof. BV Moses Centre for Evidence-Informed Healthcare and Health Policy; Christian Medical College; Vellore India
| | - Kevin Tan
- National Neuroscience Institute; Singapore Singapore
| | - Venugopalan Y Vishnu
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Doreen Fialho
- Department of Clinical Neurophysiology; King's College Hospital; London UK
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Ellis RJ, Diaz M, Sacktor N, Marra C, Collier AC, Clifford DB, Calcutt N, Fields JA, Heaton RK, Letendre SL. Predictors of worsening neuropathy and neuropathic pain after 12 years in people with HIV. Ann Clin Transl Neurol 2020; 7:1166-1173. [PMID: 32619341 PMCID: PMC7359117 DOI: 10.1002/acn3.51097] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Distal sensory polyneuropathy (DSP) and neuropathic pain are important clinical concerns in virally suppressed people with HIV. We determined how these conditions evolved, what factors influenced their evolution, and their clinical impact. METHODS Ambulatory, community-dwelling HIV seropositive individuals were recruited at six research centers. Clinical evaluations at baseline and 12 years later determined neuropathy signs and distal neuropathic pain (DNP). Additional assessments measured activities of daily living and quality of life (QOL). Factors potentially associated with DSP and DNP progression included disease severity, treatment, demographics, and co-morbidities. Adjusted odds ratios were calculated for follow-up neuropathy outcomes. RESULTS Of 254 participants, 21.3% were women, 57.5% were non-white. Mean baseline age was 43.5 years. Polyneuropathy prevalence increased from 25.7% to 43.7%. Of 173 participants initially pain-free, 42 (24.3%) had incident neuropathic pain. Baseline risk factors for incident pain included unemployment (OR [95% CI], 5.86 [1.97, 17.4]) and higher baseline body mass index (BMI) (1.78 [1.03, 3.19] per 10-units). Participants with neuropathic pain at follow-up had significantly worse QOL and greater dependence in activities of daily living than those who remained pain-free. INTERPRETATION HIV DSP and neuropathic pain increased in prevalence and severity over 12 years despite high rates of viral suppression. The high burden of neuropathy included disability and poor life quality. However, substantial numbers remained pain-free despite clear evidence of neuropathy on exam. Protective factors included being employed and having a lower BMI. Implications for clinical practice include promotion of lifestyle changes affecting reversible risk factors.
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Affiliation(s)
- Ronald J. Ellis
- Departments of Neurosciences and PsychiatryUniversity of California, San DiegoLa JollaCalifornia
| | - Monica Diaz
- Department of MedicineUniversity of California, San DiegoLa JollaCalifornia
| | - Ned Sacktor
- Department of NeurologyJohns Hopkins UniversityBaltimoreMaryland
| | - Christina Marra
- Department of NeurologyUniversity of WashingtonSeattleWashington
| | - Ann C. Collier
- Department of MedicineUniversity of WashingtonSeattleWashington
| | | | - Nigel Calcutt
- Department of PathologyUniversity of California, San DiegoLa JollaCalifornia
| | - Jerel A. Fields
- Department of PsychiatryUniversity of California, San DiegoLa JollaCalifornia
| | - Robert K. Heaton
- Department of PsychiatryUniversity of California, San DiegoLa JollaCalifornia
| | - Scott L. Letendre
- Departments of Medicine and PsychiatryUniversity of California, San DiegoLa JollaCalifornia
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Pain in Clients Attending a South African Voluntary Counseling and Testing Center Was Frequent and Extensive But Did Not Depend on HIV Status. J Acquir Immune Defic Syndr 2020; 83:181-188. [PMID: 31929406 DOI: 10.1097/qai.0000000000002248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The frequency of pain is reported to be high in people living with HIV, but valid comparisons between people living with HIV and HIV-negative cohorts are rare. We investigated whether HIV infection influenced frequency and characteristics of pain in adults undergoing voluntary testing for HIV. SETTING Participants were recruited from an HIV voluntary counseling and testing center at the Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. METHODS Pain was assessed using the Wisconsin Brief Pain Questionnaire. Depressive and anxiety symptomatology was determined using the Hopkins Symptom checklist-25. We then stratified by HIV status. RESULTS Data from 535 black South Africans were analyzed: HIV-infected n = 70, HIV-uninfected n = 465. Overall, frequency of any current pain was high with 59% [95% confidence interval (CI): 55 to 63, n: 316/535] of participants reporting pain, with no difference related to HIV status: HIV-infected 50% (95% CI: 37 to 61, n: 35/70), HIV-uninfected 60% (95% CI: 56 to 65, n: 281/465). Pain intensity and number of pain sites were similar between the groups as were symptoms of anxiety and depression: mean Hopkins Symptom Checklist-25 1.72 (95% CI: 1.57 to 1.87) HIV-infected participants and 1.68 (95% CI: 1.63 to 1.73) HIV-uninfected participants. Univariate analysis showed female sex and greater depressive and anxiety symptomatology associated with pain. In a multivariable modeling, only depressive and anxiety symptomatology was retained in the model. CONCLUSION The high frequency of pain found in both HIV-infected and HIV-uninfected individuals presenting at a voluntary counseling and testing center was more likely to be associated with depression and anxiety, than with the presence or absence of HIV.
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Barriers to implementing clinical trials on nonpharmacological treatments in developing countries: lessons learnt from addressing pain in HIV. Pain Rep 2020; 4:e783. [PMID: 31984291 PMCID: PMC6903358 DOI: 10.1097/pr9.0000000000000783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/13/2019] [Accepted: 08/01/2019] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Pain affects over half of the people living with HIV/AIDS (LWHA), and pharmacological treatment has limited efficacy. Preliminary evidence supports nonpharmacological interventions. We previously piloted a multimodal intervention in amaXhosa women LWHA and chronic pain in South Africa with improvements seen in all outcomes, in both intervention and control groups. A multicentre, single-blind randomised controlled trial with 160 participants recruited was conducted to determine whether the multimodal peer-led intervention reduced pain in different populations of both male and female South Africans LWHA. Participants were followed up at weeks 4, 8, 12, 24, and 48 to evaluate effects on the primary outcome of pain, and on depression, self-efficacy, and health-related quality of life. We were unable to assess the efficacy of the intervention due to a 58% loss to follow-up (LTFU). Secondary analysis of the LTFU found that sociocultural factors were not predictive of LTFU. Depression, however, did associate with LTFU, with greater severity of depressive symptoms predicting LTFU at week 8 (P = 0.01). We were unable to evaluate the effectiveness of the intervention due to the high LTFU and the risk of retention bias. The different sociocultural context in South Africa may warrant a different approach to interventions for pain in HIV compared with resource-rich countries, including a concurrent strategy to address barriers to health care service delivery. We suggest that assessment of pain and depression need to occur simultaneously in those with pain in HIV. We suggest investigation of the effect of social inclusion on pain and depression.
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14
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Zhou X, Tao L, Zhao M, Wu S, Obeng E, Wang D, Zhang W. Wnt/ β-catenin signaling regulates brain-derived neurotrophic factor release from spinal microglia to mediate HIV 1 gp120-induced neuropathic pain. Mol Pain 2020; 16:1744806920922100. [PMID: 32354292 PMCID: PMC7227158 DOI: 10.1177/1744806920922100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 12/14/2022] Open
Abstract
HIV-associated neuropathic pain (HNP) is a common complication for AIDS patients. The pathological mechanism governing HNP has not been elucidated, and HNP has no effective analgesic treatment. Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophic factor family related to the plasticity of the central nervous system. BDNF dysregulation is involved in many neurological diseases, including neuropathic pain. However, to the best of our knowledge, the role and mechanism of BDNF in HNP have not been elucidated. In this study, we explored this condition in an HNP mouse model induced by intrathecal injection of gp120. We found that Wnt3a and β-catenin expression levels increased in the spinal cord of HNP mice, consequently regulating the expression of BDNF and affecting hypersensitivity. In addition, the blockade of Wing-Int/β-catenin signaling, BDNF/TrkB or the BDNF/p75NTR pathway alleviated mechanical allodynia. BDNF immunoreactivity was colocalized with spinal microglial cells, which were activated in HNP mice. Inhibition of spinal microglial cell activation by minocycline relieved mechanical allodynia in HNP mice. This study helped to elucidate the role of the Wing-Int/β-catenin/BDNF signaling axis in HNP and may establish a foundation for further research investigating the Wing-Int/β-catenin/BDNF signaling axis as a target for HNP treatment.
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Affiliation(s)
- Xinxin Zhou
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Science and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Lei Tao
- School of Life Sciences, East China Normal University, Shanghai, China
| | - Mengru Zhao
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Science and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Shengjun Wu
- Clinical Laboratory of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Enoch Obeng
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Science and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Dan Wang
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Science and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Wenping Zhang
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Science and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
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15
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Mangus LM, Weinberg RL, Knight AC, Queen SE, Adams RJ, Mankowski JL. SIV-Induced Immune Activation and Metabolic Alterations in the Dorsal Root Ganglia During Acute Infection. J Neuropathol Exp Neurol 2019; 78:78-87. [PMID: 30500918 DOI: 10.1093/jnen/nly111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Human immunodeficiency virus-associated sensory neuropathy (HIV-SN) remains a frequent neurologic complication of HIV infection. Little is known about alterations in the peripheral nervous system during the early stages of HIV, a time when neuroprotective interventions may be most beneficial. We performed Nanostring gene expression analysis on lumbar dorsal root ganglia (DRG) from 6 simian immunodeficiency virus (SIV)-infected pigtailed macaques killed at 7 days post-inoculation and 8 uninfected controls. We found significant upregulation of many genes involved in immune signaling and activation in the DRG. Among genes related to glutamate metabolism, there was significant upregulation of glutamine synthetase (GS), while glutaminase (GLS) was downregulated. Several genes involved in the oxidative stress response also showed significant differential regulation in the DRG of 7d SIV-infected animals, with superoxide dismutase-2 (SOD2) showing the greatest median fold change compared to controls. Novel findings in the DRG were compared to corresponding brain data and further investigated at the protein level by Western blotting and immunohistochemistry. Together with our previous finding of significant epidermal nerve fiber loss at 14 days post-SIV infection, results of this study demonstrate that immune activation and altered cellular metabolism at in the DRG precede and likely contribute to early sensory nerve injury in HIV-SN.
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Affiliation(s)
- Lisa M Mangus
- Department of Molecular and Comparative Pathobiology
| | | | | | | | | | - Joseph L Mankowski
- Department of Molecular and Comparative Pathobiology.,Department of Neurology.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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16
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Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55120762. [PMID: 31795171 PMCID: PMC6956009 DOI: 10.3390/medicina55120762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Among HIV infection symptoms, sensory neuropathy (HIV-SN) remains a main cause of suffering, with incidence varying from 13-50%. So far, numerous pharmacological and non-pharmacological treatments have been tested, although few evidence-based analgesic options are available. We conducted an up-to-date systematic review and meta-analysis of the literature in order to evaluate the efficacy and safety of pharmacologic and non-pharmacologic treatments for pain control, in patients with HIV neuropathy. Materials and Methods: We searched MEDLINE, EMBASE, Scopus/Elsevier, The Cochrane Central Register of Controlled Trials (CENTRAL), USA Clinical Trials registry, and The International Web of Science up to April 2019. All randomized controlled trials evaluating efficacy and safety of non-pharmacologic and pharmacologic therapies were included. Efficacy was defined as pain reduction during the study period. Safety was estimated from adverse events. A meta-analysis was performed whenever possible. Results: 27 randomized controlled trials (RCTs) were included for analysis (7 evaluating non pharmacologic interventions, 20 pharmacologic therapies). Non-pharmacologic studies (n = 742) involved seven different therapeutic modalities. Only Acupuncture/Moxibustion showed pain reduction over placebo, Gracely Pain Scale Mean (SD): Acu/Moxa 0.85 (0.12), placebo 1.10 (0.09), p = 0.05. Pharmacologic studies, involving 2516 patients revealed efficacy for capsaicin 8% over placebo (mean difference -8.04 [95% CI: -14.92 -1.15], smoked cannabis (where pooling data for meta-analysis was not possible) and recombinant Nerve Growth Factor. Conclusion: Despite various modalities for pain control in HIV-SN, strongest evidence exists for capsaicin 8% and smoked cannabis, although of low methodological quality. Among non-pharmacologic modalities, only Acu/Moxa gave a marginal beneficial effect in one study, possibly limited by inherent methodological flaws.
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17
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Pillay P, Wadley AL, Cherry CL, Karstaedt AS, Kamerman PR. Clinical diagnosis of sensory neuropathy in HIV patients treated with tenofovir: A 6-month follow-up study. J Peripher Nerv Syst 2019; 24:304-313. [PMID: 31587421 DOI: 10.1111/jns.12349] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sensory neuropathy (SN) is a common and often painful neurological condition associated with HIV-infection and its treatment. However, data on the incidence of SN in neuropathy-free individuals initiating combination antiretroviral therapies (cART) that do not contain the neurotoxic agent stavudine are lacking. AIMS We investigated the 6-month incidence of SN in ART naïve individuals initiating tenofovir (TDF)-based cART, and the clinical factors associated with the development of SN. METHODS 120 neuropathy-free and ART naïve individuals initiating cART at a single center in Johannesburg, South Africa were enrolled. Participants were screened for SN using clinical signs and symptoms at study enrolment and approximately every 2-months for a period of ~6-months. Diagnostic criteria for symptomatic SN was defined by the presence of at least one symptom (pain/burning, numbness, paraesthesias) and at least two clinical signs (reduced vibration sense, absent ankle reflexes or pin-prick hypoaesthesia). Diagnostic criteria for asymptomatic SN required at least two clinical signs only (as above). RESULTS A total of 88% of the cohort completed three visits within the 6-month period. The 6-month cumulative incidence of neuropathy was 140 cases per 1000 patients (95% CI: 80-210) at an incidence rate of 0.37 (95% CI: 0.2-0.5) per person year. Height and active tuberculosis (TB) disease were independently associated with the risk of developing SN (P < .05). INTERPRETATION We found that within the first 6 months of starting cART, incident SN persists in the post-stavudine era, with 11 (9%) of individuals developing asymptomatic SN, and 9 (8%) developing symptomatic SN.
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Affiliation(s)
- Prinisha Pillay
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Antonia L Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine L Cherry
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Alan S Karstaedt
- Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Peter R Kamerman
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia
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18
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Puplampu P, Ganu V, Kenu E, Kudzi W, Adjei P, Grize L, Käser M. Peripheral neuropathy in patients with human immunodeficiency viral infection at a tertiary hospital in Ghana. J Neurovirol 2019; 25:464-474. [PMID: 31028691 PMCID: PMC6746675 DOI: 10.1007/s13365-019-00743-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/01/2019] [Accepted: 03/21/2019] [Indexed: 01/11/2023]
Abstract
Peripheral neuropathy (PN) is the most frequent neurological complication in people living with HIV/AIDS. Neurological damage was identified to not only be caused by the viral infection itself but also through neurotoxic antiretroviral therapy (ART). PN is associated with a variety of risk factors; however, detailed knowledge is scarce for sub-Saharan African populations, bearing among the highest HIV/AIDS infection burden.In a cross-sectional study, we assessed the prevalence of PN in 525 adult outpatients suffering from HIV/AIDS and admitted to the largest tertiary hospital in Ghana. Through a detailed questionnaire and clinical examination including neurologic assessment and laboratory blood sample testing, this study investigated associations of PN with demographic and health determinants and identified risk factors associated with sensory neuropathy.The prevalence of PN in the Ghanaian cohort was 17.7% and increased odd ratios (OR) when patients were taller (> 1.57 m; OR = 3.84; 95% CI 1.38-10.66) or reached the age > 34 years (p = 0.124). Respondents with longer education duration had significantly less PN (≥ 9 years of education; OR = 0.49; 95% CI 0.26-0.92). The study also identified significant association of PN to both waist and hip girth and neutrophil counts. Curiously, higher adjusted odd ratios (aOR) of PN of patients under ART treatment were observed when CD4 lymphocytes were elevated (aOR = 0.81; 95% CI 0.36-1.83 and aOR = 2.17; 95% CI 0.93-5.05, for 300 and 600 counts, respectively). For patients on ART, an increase of 10 CD4 cell count units increased their chance of developing PN by 1% (aOR = 1.01; 95% CI 1.00 to 1.03).Despite current drug application regulations, prevalence of PN is still unacceptably high in sub-Saharan African populations. Reduction in chronic morbidity through a health system with routine monitoring, early diagnosis and prompt intervention, and effective case management can improve people living with HIV/AIDS' quality of life.
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Affiliation(s)
- Peter Puplampu
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vincent Ganu
- Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Ernest Kenu
- Department of Epidemiology, School of Public Health, University of Ghana, Accra, Ghana
| | - William Kudzi
- Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, Accra, Ghana
| | - Patrick Adjei
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Leticia Grize
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Michael Käser
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
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19
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Wadley AL, Pincus T, Evangeli M. A preliminary analysis of the association between perceived stigma and HIV-related pain in South Africans living with HIV. Afr J Prim Health Care Fam Med 2019; 11:e1-e5. [PMID: 30843417 PMCID: PMC6407439 DOI: 10.4102/phcfm.v11i1.1647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 10/08/2018] [Accepted: 10/14/2018] [Indexed: 12/27/2022] Open
Abstract
Background Stigma related to the human immunodeficiency virus (HIV) remains common and has been associated with severity of HIV-related symptoms. Associations between HIV stigma and HIV-related pain, one of the most common symptoms in HIV, have however not been investigated. Data from low back pain populations suggest that stigma is associated with worse pain intensity and so we hypothesised that the same would be the case in HIV. Aim The goal of this study was to assess the association between HIV stigma and pain intensity in people living with HIV (PLWH) with chronic pain whilst controlling for depression, a well-established correlate of pain. Setting The study took place at an HIV clinic in Johannesburg, South Africa. Methods Mediation analysis was used to assess the effect of depression on the relationship between stigma and pain intensity in a cross-sectional cohort of 50 PLWH and chronic pain (pain most days of the week for > 3 months). All participants were assessed using the HIV/AIDS Stigma Instrument – PLWA, an 11-point numerical pain rating scale and the Beck Depression Inventory II. Results In all, 88% (44/50) of participants reported experiencing some form of HIV stigma (HIV stigma scale score ≥ 1). Worst pain intensity and depressive symptoms individually correlated with total stigma score (Spearman’s r = 0.33, p = 0.02 for both). The mediation analysis highlighted that mediation of the relationship by depression was equivocal (b = -0.002, bootstrapped confidence interval -0.02 to 0.00). Conclusion Whilst these preliminary data are marginal, they do suggest that associations between HIV stigma and HIV-related pain warrant further investigation. Future study should also include potential mechanisms, which may include mediation through depression.
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Affiliation(s)
- Antonia L Wadley
- Brain Function Research Group, School of Physiology, University of the Witwatersrand.
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20
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Scott W, Arkuter C, Kioskli K, Kemp H, McCracken LM, Rice AS, de C. Williams AC. Psychosocial factors associated with persistent pain in people with HIV: a systematic review with meta-analysis. Pain 2018; 159:2461-2476. [PMID: 30130299 PMCID: PMC6250281 DOI: 10.1097/j.pain.0000000000001369] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/26/2018] [Indexed: 01/11/2023]
Abstract
Chronic pain remains a prevalent and disabling problem for people living with HIV in the current antiretroviral treatment era. Psychosocial treatments may have promise for managing the impact of this pain. However, research is needed to identify psychosocial processes to target through such treatments. The current systematic review and meta-analysis examined the evidence for psychosocial factors associated with pain, disability, and quality of life in people living with HIV and persistent pain. Observational and experimental studies reporting on the association between one or more psychosocial factors and one or more pain-related variables in an adult sample of people living with HIV and pain were eligible. Two reviewers independently conducted eligibility screening, data extraction, and quality assessment. Forty-six studies were included in the review and 37 of these provided data for meta-analyses (12,493 participants). "Some" or "moderate" evidence supported an association between pain outcomes in people with HIV and the following psychosocial factors: depression, psychological distress, posttraumatic stress, drug abuse, sleep disturbance, reduced antiretroviral adherence, health care use, missed HIV clinic visits, unemployment, and protective psychological factors. Surprisingly, few studies examined protective psychological factors or social processes, such as stigma. There were few high-quality studies. These findings can inform future research and psychosocial treatment development in this area. Greater theoretical and empirical focus is needed to examine the role of protective factors and social processes on pain outcomes in this context. The review protocol was registered with PROSPERO (CRD42016036329).
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Affiliation(s)
- Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Chinar Arkuter
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Kitty Kioskli
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Harriet Kemp
- Pain Research Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lance M. McCracken
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew S.C. Rice
- Pain Research Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Amanda C. de C. Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
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