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Wong RJ, Loeb R, Seal KH, Barry F, Stark Kent D, Seetharaman S, Sharma A, Lai JC, Rubin JB. The Complex Relationship Between Pain, Mental Health, and Quality-of-Life in Patients With Cirrhosis Undergoing Liver Transplant Evaluation. J Clin Gastroenterol 2024:00004836-990000000-00313. [PMID: 39008614 DOI: 10.1097/mcg.0000000000002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/05/2024] [Indexed: 07/17/2024]
Abstract
GOALS AND BACKGROUND Patients with cirrhosis undergoing liver transplant evaluation have high rates of pain and mental health comorbidities; both may significantly impair health-related quality of life (HRQL). We investigated the association between pain, anxiety/depression, and HRQL in this population. STUDY In 62 patients with cirrhosis undergoing liver transplant evaluation, we performed 4 validated assessments to characterize: pain (Brief Pain Inventory-Short Form, BPI-SF), anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-8), and liver-specific HRQL (Chronic Liver Disease Questionnaire). The presence of pain was determined using the BPI-SF screening question. Linear regression was used to identify demographic or clinical factors predictive of pain severity (PS) and interference (PI) and to evaluate the association between pain, anxiety/depression, and HRQL. RESULTS Seventy-one percent of patients reported pain, 26% had clinical depression, and 24% had moderate-severe anxiety. Neither liver disease severity, nor its complications were associated with pain (PS or PI), but anxiety and depression were predictors of pain on bivariate analysis. Only depression remained a significant predictor of PS (b=0.28, P<0.05) and PI (b=0.30, P<0.05) in multivariable models. HRQL was inversely associated with PS, PI, depression, and anxiety, but only anxiety (b=-0.14, P=0.003) remained associated with HRQL in the adjusted model. CONCLUSIONS Pain is present in over 70% of patients with cirrhosis undergoing liver transplant evaluation. Anxiety and depression were highly correlated with pain and appeared to be key drivers in predicting poor HRQL. Evaluating and managing mental health comorbidities should be explored as a strategy to improve HRQL in patients with cirrhosis and pain.
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Affiliation(s)
- Randi J Wong
- University of California, San Francisco , Department of Medicine San Francisco, CA
- University of South Florida Morsani College of Medicine, Department of Medicine Tampa, FL
| | - Rebecca Loeb
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Karen H Seal
- University of California, San Francisco , Department of Medicine San Francisco, CA
- San Francisco VA Medical Center Department of Medicine, San Francisco, CA
| | - Fawzy Barry
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Dorothea Stark Kent
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Sri Seetharaman
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Arjun Sharma
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Jennifer C Lai
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Jessica B Rubin
- University of California, San Francisco , Department of Medicine San Francisco, CA
- San Francisco VA Medical Center Department of Medicine, San Francisco, CA
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2
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Stein MD, Godersky ME, Kim TW, Walley AY, Heeren TC, Winter MR, Magane KM, Saitz R. Self-medication of pain and discomfort with alcohol and other substances by people with HIV infection and substance use disorder: preliminary findings from a secondary analysis. AIDS Care 2024; 36:414-424. [PMID: 37909062 PMCID: PMC10922286 DOI: 10.1080/09540121.2023.2275047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
There is a limited literature regarding factors associated with self-medication of pain and discomfort using alcohol, non-prescription substances or overuse of prescription medications among people living with Human Immunodeficiency Virus (HIV). This cross-sectional analysis used data from the Boston ARCH Cohort among participants with HIV infection and a history of alcohol or other substance use. Among 248 participants, 37% were female, 50% Black, 25% Latinx; 36% reported fair to poor health and 89% had CD4 cell counts >200/mm3. Half reported self-medication and of those, 8.8% reported doing so only with alcohol, 48.8% only with other substances and 42.4% with both alcohol and other substances. Those reporting self-medication were significantly (p < .05) younger (mean 47 vs 50 years), less employed (11% vs 21%), and less likely to have HIV viral suppression (60% vs. 80%). Depression, anxiety, and HIV symptoms were associated with significantly greater odds of self-medicating, as were substance dependence, recent injection substance use, heavy alcohol use, cocaine use, opioid use, sedative use, and cannabis use. Self-medication, highly prevalent and associated with worse mental health symptoms, greater substance use, and lesser HIV disease control, should be explored by HIV clinicians caring for people who use substances.
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Affiliation(s)
- Michael D. Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health. 715 Albany Street, Boston, MA, USA 02118
| | - Margo E. Godersky
- SORCE, Department of Surgery, University of Washington Medical Center, 1107 NE 45th Street, Suite 502 Seattle, WA, USA 98105
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA, USA 02118
| | - Theresa W. Kim
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Grayken Center for Addiction, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave., Boston, MA, USA 02118
| | - Alexander Y. Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Grayken Center for Addiction, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave., Boston, MA, USA 02118
| | - Timothy C. Heeren
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health 85 East Newton Street, 9th Floor, Boston, MA, USA 02118
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health 85 East Newton Street, 9th Floor, Boston, MA, USA 02118
| | - Kara M. Magane
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA, USA 02118
| | - Richard Saitz
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Grayken Center for Addiction, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave., Boston, MA, USA 02118
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA, USA 02118
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3
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Tseng TY, Mitchell MM, Chander G, Latkin C, Kennedy C, Knowlton AR. Patient-centered Engagement as a Mediator in the Associations of Healthcare Discrimination, Pain Care Denial, and Later Substance Use Among a Sample of Predominately African Americans Living with HIV. AIDS Behav 2024; 28:429-438. [PMID: 38060111 DOI: 10.1007/s10461-023-04235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Chronic pain is prevalent and often under-addressed among people with HIV and people who use drugs, likely compounding the stress of discrimination in healthcare, and self-medicating along with its associated overdose risk or other problematic coping. Due to challenges in treating pain and HIV in the context of substance use, collaborative, patient-centered patient-provider engagement (PCE) may be particularly important for mitigating the impact of pain on illicit drug use and promoting sustained recovery. We examined whether PCE with primary care provider (PCE-PCP) mediated the effects of pain, discrimination, and denial of prescription pain medication on later substance use for pain among a sample of 331 predominately African Americans with HIV and a drug use history in Baltimore, Maryland, USA. Baseline pain level was directly associated with a higher chance of substance use for pain at 12 months (Standardized Coefficient = 0.26, p < .01). Indirect paths were observed from baseline healthcare discrimination (Standardized Coefficient = 0.05, 95% CI=[0.01, 0.13]) and pain medication denial (Standardized Coefficient = 0.06, 95% CI=[0.01, 0.14]) to a higher chance of substance use for pain at 12 months. Effects of prior discrimination and pain medication denial on later self-medication were mediated through worse PCE-PCP at 6 months. Results underscore the importance of PCE interpersonal skills and integrative care models in addressing mistreatment in healthcare and substance use in this population. An integrated approach for treating pain and substance use disorders concurrently with HIV and other comorbidities is much needed. Interventions should target individuals at multiple risks of discriminations and healthcare professionals to promote PCE.
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Affiliation(s)
- Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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4
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Taylor SW, McKetchnie SM, Batchelder AW, Justice A, Safren SA, O’Cleirigh C. Chronic pain and substance use disorders among older sexual minority men living with HIV: Implications for HIV disease management across the HIV care continuum. AIDS Care 2023; 35:614-623. [PMID: 35653300 PMCID: PMC9715850 DOI: 10.1080/09540121.2022.2076801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
HIV continues to be a critical health issue for sexual minority men (SMM) in the USA. Chronic pain is common in individuals with HIV, including older SMM, and is associated with substance use behaviors. This cross-sectional study sought to address a gap in the literature by characterizing interrelationships among chronic pain, substance use disorders (SUDs), medication adherence, and engagement in HIV care among older (≥50) SMM living with HIV and chronic pain (N = 63). The unadjusted relationship between an opioid use disorder and pain indicated that participants with an opioid use disorder reported higher pain ratings than those without. Presence of alcohol use disorder was significantly associated with missed HIV-care appointments due to chronic pain or substance use, showing that individuals with an alcohol use disorder reported more missed appointments in the past year. Higher pain was significantly associated with the same missed appointments variable, such that those reporting higher pain ratings also reported more missed appointments in the past year. These findings provide preliminary evidence of the interrelationships among chronic pain, SUDs, and engagement in HIV care among older SMM living with HIV and suggest that pain management in this population might support fuller engagement in HIV care.
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Affiliation(s)
- S. Wade Taylor
- Boston University School of Social Work, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Samantha M. McKetchnie
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Abigail W. Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Amy Justice
- Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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5
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Ellis RJ, Chenna A, Lie Y, Curanovic D, Winslow J, Tang B, Marra CM, Rubin LH, Clifford DB, McCutchan JA, Gelman BB, Robinson-Papp J, Petropoulos CJ, Letendre SL. Higher Levels of Cerebrospinal Fluid and Plasma Neurofilament Light in Human Immunodeficiency Virus-Associated Distal Sensory Polyneuropathy. Clin Infect Dis 2023; 76:1103-1109. [PMID: 36310512 PMCID: PMC10226757 DOI: 10.1093/cid/ciac851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/13/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Neurofilament light (NFL) chain concentrations, reflecting axonal damage, are seen in several polyneuropathies but have not been studied in human immunodeficiency virus (HIV) distal sensory polyneuropathy (DSP). We evaluated NFL in cerebrospinal fluid (CSF) and plasma in relation to DSP in people with HIV (PWH) from 2 independent cohorts and in people without HIV (PWoH). METHODS Cohort 1 consisted of PWH from the CHARTER Study. Cohort 2 consisted of PWH and PWoH from the HIV Neurobehavioral Research Center (HNRC). We evaluated DSP signs and symptoms in both cohorts. Immunoassays measured NFL in CSF for all and for plasma as well in Cohort 2. RESULTS Cohort 1 consisted of 111 PWH, mean ± SD age 56.8 ± 8.32 years, 15.3% female, 38.7% Black, 49.6% White, current CD4+ T-cells (median, interquartile range [IQR]) 532/µL (295, 785), 83.5% with plasma HIV RNA ≤50 copies/mL. Cohort 2 consisted of 233 PWH of similar demographics to PWH in Cohort 1 but also 51 PWoH, together age 58.4 ± 6.68 years, 41.2% female, 18.0% Black, Hispanic, non-Hispanic White 52.0%, 6.00% White. In both cohorts of PWH, CSF and plasma NFL were significantly higher in both PWH with DSP signs. Findings were similar, albeit not significant, for PWoH. The observed relationships were not explained by confounds. CONCLUSIONS Both plasma and CSF NFL were elevated in PWH and PWoH with DSP. The convergence of our findings with others demonstrates that NFL is a reliable biomarker reflecting peripheral nerve injury. Biomarkers such as NFL might provide, validate, and optimize clinical trials of neuroregenerative strategies in HIV DSP.
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Affiliation(s)
- Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, San Diego, California, USA
| | - Ahmed Chenna
- Monogram Biosciences, South San Francisco, California, USA
| | - Yolanda Lie
- Monogram Biosciences, South San Francisco, California, USA
| | | | - John Winslow
- Monogram Biosciences, South San Francisco, California, USA
| | - Bin Tang
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Christina M Marra
- Deparment of Neurology, University of Washington, Seattle, Washington, USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - David B Clifford
- Department of Neurology, Washington University at St. Louis, St. Louis, Missouri, USA
| | - J Allen McCutchan
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Benjamin B Gelman
- Department of Neuroscience and Cell Biology, UTMB, Galveston, Texas, USA
| | - Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | | | - Scott L Letendre
- Departments of Medicine and Psychiatry, University of California, San Diego, San Diego, California, USA
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6
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Yeh JC, Uebelacker LA, Pinkston MM, Anderson BJ, Busch AM, Abrantes AM, Baker JV, Stein MD. Anger and substance use in HIV-positive patients with chronic pain. AIDS Care 2023; 35:271-279. [PMID: 35727161 PMCID: PMC9768096 DOI: 10.1080/09540121.2022.2090490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
Chronic pain increases the risk of substance use in people living with HIV (PLWH). Depression and anxiety have also been identified as risk factors for substance use among PLWH. Relatedly, other negative mood states, such as anger, may influence chronic pain among PLWH. The current cross-sectional study examined whether the distinct negative mood state of anger is associated with substance use among 187 PLWH who report chronic pain. Using negative binomial regression analyses, we found higher levels of anger were positively associated with alcohol use. Higher levels of anger were inversely associated with benzodiazepine use. No association was found between anger and marijuana use, and there were no significant interactions between anger and pain severity on substance use. Our findings suggest that anger is an independent risk factor for substance use among PLWH and chronic pain. Addressing anger may be useful when adapting behavioral therapies in the treatment of pain among PLWH.
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Affiliation(s)
- Jih-Cheng Yeh
- Department of Health Law, Policy, and Management, Boston
University School of Public Health, Boston, MA, United States
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical
School of Brown University, Providence RI, USA
- Department of Family Medicine, Alpert Medical School of
Brown University, Providence, RI, USA
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906
USA
| | - Megan M. Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical
School of Brown University, Providence RI, USA
- Department of Medicine, Alpert Medical School of Brown
University, Providence, RI, USA
- Lifespan Physicians Group, The Miriam Hospital, Providence
RI, USA
| | | | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis
MN, USA
- Department of Medicine, University of Minnesota - Twin
Cities, Minneapolis MN, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical
School of Brown University, Providence RI, USA
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906
USA
| | - Jason V. Baker
- Department of Medicine, University of Minnesota - Twin
Cities, Minneapolis MN, USA
- Division of Infectious Diseases, Hennepin County Medical
Center, Minneapolis, MN
| | - Michael D. Stein
- Department of Health Law, Policy, and Management, Boston
University School of Public Health, Boston, MA, United States
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906
USA
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7
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Wilson JM, Haliwa I, Lee J, Shook NJ. The role of dispositional mindfulness in the fear-avoidance model of pain. PLoS One 2023; 18:e0280740. [PMID: 36706069 PMCID: PMC9882899 DOI: 10.1371/journal.pone.0280740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The fear-avoidance model of pain posits that a painful stimulus is interpreted through pain catastrophizing, which leads to negative downstream cognitions, emotions, and behaviors that shape the experience of pain. As dispositional mindfulness is associated with less catastrophizing and pain, some researchers have suggested incorporating mindfulness into the fear-avoidance model. Across two studies, we empirically tested dispositional mindfulness as a stand-alone component within the fear-avoidance model of pain. METHODS Two independent, online cross-sectional surveys (Ns = 362 and 580 U.S. adults) were conducted. Participants completed validated assessments of mindfulness, pain catastrophizing, fear of pain, pain vigilance, depression, pain intensity, and pain sensitivity. Using structural equation modeling, we tested the inclusion of dispositional mindfulness in the fear-avoidance model of pain. We proposed that greater mindfulness would be associated with less pain catastrophizing, which in turn would be associated with less fear of pain, leading to less depression, and then ultimately less pain intensity and pain sensitivity. RESULTS Across both studies, the fear-avoidance model of pain did not fit the data well, with or without mindfulness included. We found that a simplified model fit the data best (Study 1: χ2/df = 1.83; CFI = .981; RMSEA = .049, 90% CI [0.019, 0.076]; SRMR = 0.031; Study 2: χ2/df = 2.23; CFI = .976; RMSEA = .046, 90% CI [0.026, 0.067]; SRMR = .031), such that greater mindfulness was significantly associated with less pain catastrophizing and, in turn, lower levels of pain intensity and pain sensitivity. CONCLUSION Our findings suggest that a simplified model, compared to the traditional fear-avoidance model, may partly explain the experience of pain among individuals without chronic pain. Future work should examine the temporal associations among these variables to inform the employment of future empirically supported interventions for pain management.
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Affiliation(s)
- Jenna M. Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Ilana Haliwa
- Department of Psychology, Salve Regina University, Newport, RI, United States of America
| | - Jerin Lee
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States of America
| | - Natalie J. Shook
- Department of Psychology, Salve Regina University, Newport, RI, United States of America
- School of Nursing, University of Connecticut, Storrs, CT, United States of America
- * E-mail:
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8
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Ellis RJ, Sacktor N, Clifford DB, Marra CM, Collier AC, Gelman B, Robinson-Papp J, Letendre SL, Heaton RK. Neuropathic pain correlates with worsening cognition in people with human immunodeficiency virus. Brain 2022; 145:2206-2213. [PMID: 35773234 DOI: 10.1093/brain/awab462] [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: 04/14/2021] [Revised: 09/21/2021] [Accepted: 11/26/2021] [Indexed: 11/14/2022] Open
Abstract
Neuropathic pain and cognitive impairment are among the HIV-related conditions that have most stubbornly resisted amelioration by virally suppressive antiretroviral therapy. Overlaps between the regional brain substrates and mechanisms of neuropathic pain and cognitive disorders are increasingly recognized, yet no studies have examined the longitudinal relationship between these two disorders. Participants in the prospective, observational CNS HIV AntiRetroviral Therapy Effects Research (CHARTER) cohort underwent standardized clinical evaluations for clinical examination findings of distal sensory polyneuropathy, reporting distal neuropathic pain and neurocognitive performance at study entry (baseline) and an average of 12 years later. Change in neuropathic pain and neuropathy status from baseline to follow-up was by self-report and repeat examination, and change in neurocognitive performance was assessed using a previously published summary regression-based change score. Relationships between incident or worsened neuropathic pain and neurocognitive change were evaluated using uni- and multivariable regressions, including age at baseline and other relevant covariates. Participants were 385 people with HIV, 91 (23.6%) females, mean ± standard deviation (SD) age at baseline 43.5 (7.81) years, ethnicity 44.9% African American, 10.6% Hispanic, 42.6% non-Hispanic white and 1.82% other. Baseline median (interquartile range) nadir CD4 was 175 (34 309) cells/µl and current CD4 was 454 (279 639). Incident or worsened distal neuropathic pain occurred in 98 (25.5%) over the follow-up period. People with HIV with incident or worsened distal neuropathic pain had significantly worsened neurocognitive performance at follow-up compared to those without incident or worsened distal neuropathic pain (summary regression-based change score mean ± SD -0.408 ± 0.700 versus -0.228 ± 0.613; P = 0.0158). This effect remained significant when considering viral suppression on antiretroviral therapy, incident diabetes and other covariates as predictors. Overall neurocognitive change related to neuropathic pain was driven primarily by changes in the domains of executive function and speed of information processing. Those with incident distal neuropathy signs did not have neurocognitive worsening, nor did individuals who used opioid analgesics or other pain-modulating drugs such as amitriptyline. Worsened neurocognitive performance in people with HIV was associated with worsened neuropathic pain but not with changes in physical signs of neuropathy, and this was not attributable to therapies for pain or depression or to differences in viral suppression. This finding implies that incident or worsened pain may signal increased risk for neurocognitive impairment, and deserves more investigation, particularly if better pain management might stabilize or improve neurocognitive performance.
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Affiliation(s)
- Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, CA 92103-8231, USA.,Department of Psychiatry, University of California, San Diego, CA 92103-8231, USA
| | - Ned Sacktor
- Department of Neurology, Johns-Hopkins University, Baltimore, MD 21224, USA
| | - David B Clifford
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Christina M Marra
- Department of Neurology, University of Washington, Seattle, WA 98104, USA
| | - Ann C Collier
- Department of Medicine, University of Washington, Seattle, WA 98104, USA
| | - Benjamin Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | | | - Scott L Letendre
- Department of Psychiatry, University of California, San Diego, CA 92103, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, CA 92103-8231, USA.,Department of Medicine, University of California, San Diego, CA 92103, USA
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9
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Madden VJ, Msolo N, Mqadi L, Lesosky M, Bedwell GJ, Hutchinson MR, Peter JG, Parker R, Schrepf A, Edwards RR, Joska JA. Study protocol: an observational study of distress, immune function and persistent pain in HIV. BMJ Open 2022; 12:e059723. [PMID: 36691234 PMCID: PMC9171212 DOI: 10.1136/bmjopen-2021-059723] [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: 12/15/2021] [Accepted: 04/28/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Many people with HIV report both distress and pain. The relationship between distress and pain is bidirectional, but the mechanisms by which distress exacerbates pain are unclear. The inflammatory response to challenge (inflammatory reactivity, IR) may be a partial mediator, given that neuroimmune interactions provide a substrate for IR to also influence neurological reactivity and, thus, pain-related neural signalling. This prospective, observational, case-control study will characterise the relationships between distress, IR, pain-related signalling as captured by induced secondary hyperalgesia (SH), and pain, in people with HIV who report persistent pain (PP) (cases) or no pain (controls). METHODS AND ANALYSIS One hundred people with suppressed HIV, reporting either PP or no pain, will be assessed two or four times over 6 months. The primary outcomes are distress (Hopkins 25-item symptom checklist), IR (multiplex assay after LPS challenge), and PP (Brief Pain Inventory), assessed at the baseline timepoint, although each will also be assessed at follow-up time points. Induced SH will be assessed in a subsample of 60 participants (baseline timepoint only). To test the hypothesis that IR partly mediates the relationship between distress and pain, mediation analysis will use the baseline data from the PP group to estimate direct and indirect contributions of distress and IR to pain. To test the hypothesis that IR is positively associated with SH, data from the subsample will be analysed with generalised mixed effects models to estimate the association between IR and group membership, with SH as the dependent variable. ETHICS AND DISSEMINATION Information obtained from this study will be published in peer-reviewed journals and presented at scientific meetings. The study has been approved by the Human Research Ethics Committee of the University of Cape Town (approval number: 764/2019) and the City of Cape Town (ref: 24699). TRIAL REGISTRATION NUMBER NCT04757987.
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Affiliation(s)
- Victoria J Madden
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Ncumisa Msolo
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Luyanduthando Mqadi
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Gillian J Bedwell
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mark R Hutchinson
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Grant Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Nkhoma KB, Mwalabu GT, Bristowe K, Lungu EA, Harding R. "Pain Special Issue" "Stakeholders' perspectives and requirements on pain self-management for adolescents living with HIV/AIDS in Malawi: a cross-sectional qualitative study". AIDS Care 2021:1-14. [PMID: 34152886 DOI: 10.1080/09540121.2021.1939850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Malawi has one of the highest HIV prevalence rates (8.9%), and data suggest 27% pain prevalence among adolescents living with HIV (ALHIV) in Malawi. Pain among ALHIV is often under-reported and pain management is suboptimal. We aimed to explore stakeholders' perspectives and experiences on pain self-management for ALHIV and chronic pain in Malawi. We conducted cross-sectional in-depth qualitative interviews with adolescents/caregiver dyads and healthcare professionals working in HIV clinics. Data were audio-recorded, transcribed verbatim and translated (where applicable) then imported into NVivo version 12 software for framework analysis. We identified three main themes: (1) Experiencing "total pain": adolescents experienced physical, psychosocial, and spiritual pain which impacted their daily life activities. (2) Current self-management approaches: participants prefer group-based self-management approaches facilitated by healthcare professionals or peers at the clinic focussing on self-management of physical, psychosocial, and spiritual pain. (3) Current pain strategies: participants used prescribed drugs, traditional medicine, and non-pharmacological interventions, such as exercises to manage pain. A person-centred care approach to self-management of chronic pain among ALHIV is needed to mitigate the impact of pain on their daily activities. There is a need to integrate self-management approaches within the existing structures such as teen clubs in primary care.
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Affiliation(s)
| | | | - Katherine Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, London UK
| | | | - Richard Harding
- Kings College London, Department of Palliative Care, Policy & Rehabilitation, Weston Education Centre, London, UK
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11
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Adeola J, Badejo OA, Ahonkhai A, Okonkwo P, Aboh Akande P, Evans CT, McHugh M, Pierce L, Ahmed I, Jolayemi T, Ladi Akinyemi B, Onwuatuelo I, Murphy R, Kyriacou D, Musa J, Agaba P. Effect of Baseline Symptom Manifestations on Retention in Care and Treatment among HIV-Infected Patients in Nigeria. J Int Assoc Provid AIDS Care 2021; 19:2325958220903575. [PMID: 32027211 PMCID: PMC7005974 DOI: 10.1177/2325958220903575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Symptom management is an important component of HIV care. But symptom patterns and how they affect engagement with HIV care and treatment services have not been adequately explored in the era of increased HIV treatment scale-up. We investigated the relationship between symptom patterns among people living with HIV (PLHIV) and 12 months retention in care, within the context of other clinical and demographic characteristics. METHODS Retrospective cohort analysis of 5114 PLHIV receiving care within a large HIV treatment program in Nigeria. We assessed the prevalence and burden of baseline symptoms reported during routine clinic visits from January 2015 to December 2017. Multivariable regression was used to identify relationships between 12-month retention and symptom dimensions (prevalence and burden) while controlling for demographic and other clinical variables. RESULTS Increasing symptom burden was associated with higher likelihood of retention at 12 months (adjusted odds ratio [aOR] = 1.19 [95% confidence interval, CI: 1.09-1.29]; P < .001) as was the reporting of skin rashes/itching symptom (aOR = 2.59 [95% CI: 1.65-4.09]; P < .001). Likelihood of retention reduced with increasing World Health Organization (WHO) Clinical staging, with CD4 ≥500 cells/mL and self-reported heterosexual mode of HIV transmission. Conclusions: Symptom dimensions and standardized clinical/immunological measures both predicted retention in care, but effects differed in magnitude and direction. Standardized clinical/immunological measures in HIV care (eg, WHO clinical staging and CD4 count categories) can mask important differences in how PLHIVs experience symptoms and, therefore, their engagement with HIV care and treatment. Symptom management strategies are required alongside antiretroviral treatment to improve outcomes among PLHIV, including retention in care.
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Affiliation(s)
- Juliet Adeola
- APIN Public Health Initiatives, Abuja, Nigeria.,Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA
| | - Okikiolu Abimbola Badejo
- APIN Public Health Initiatives, Abuja, Nigeria.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Aimalohi Ahonkhai
- Vanderbilt University, Division of Infectious Diseases, Nashville, TN, USA
| | | | | | - Charlesnika Tyon Evans
- Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA
| | - Megan McHugh
- Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA
| | - Leslie Pierce
- Vanderbilt University, Division of Infectious Diseases, Nashville, TN, USA
| | - Isah Ahmed
- APIN Public Health Initiatives, Abuja, Nigeria
| | | | | | | | - Robert Murphy
- Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA
| | - Demetrious Kyriacou
- Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA
| | - Jonah Musa
- Jos University Teaching Hospital, APIN Center, Plateau State, Nigeria
| | - Patricia Agaba
- Jos University Teaching Hospital, APIN Center, Plateau State, Nigeria
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12
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Madden VJ, Parker R, Goodin BR. Chronic pain in people with HIV: a common comorbidity and threat to quality of life. Pain Manag 2020; 10:253-260. [PMID: 32484065 PMCID: PMC7421257 DOI: 10.2217/pmt-2020-0004] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/16/2020] [Indexed: 12/17/2022] Open
Abstract
Evidence indicates that over half of all people with HIV (PWH) will experience nonmalignant chronic pain throughout their lifetimes, with increasing prevalence as they age. Peripheral neuropathy resulting from the neurotoxic effects of HIV itself and the medications used to treat HIV were widely considered the primary cause of acute and chronic pain early on in the antiretroviral treatment era. However, recent studies suggest a predominance of non-neuropathic (e.g., musculoskeletal) pain in PWH with uncertain etiology. Chronic pain is often widespread in PWH, affecting multiple body locations. Additional research is needed to better understand contributors to chronic pain in PWH, which is likely to include biological (e.g., immune dysregulation), psychological (e.g., substance abuse) and social (e.g., stigma) factors.
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Affiliation(s)
- Victoria J Madden
- Department of Anaesthesia & Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Romy Parker
- Department of Anaesthesia & Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Burel R Goodin
- Author for correspondence: Tel.: +1 205 934 6536; Fax: +1 205 975 6110;
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Behar E, Bagnulo R, Knight K, Santos GM, Coffin PO. "Chasing the pain relief, not the high": Experiences managing pain after opioid reductions among patients with HIV and a history of substance use. PLoS One 2020; 15:e0230408. [PMID: 32210442 PMCID: PMC7094831 DOI: 10.1371/journal.pone.0230408] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/28/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Opioid overdose mortality continues to increase in the United States despite significant investments to reverse the epidemic. The national response to-date has focused primarily on reducing opioid prescribing, yet reductions in prescribing have been associated with patients reporting uncontrolled pain, psychological distress, and transition to illicit substances. The aim of this study is to qualitatively explore chronic pain management experiences among PLWH with a history of illicit substance use after long-term opioid therapy reductions or discontinuations. METHODS We analyzed 18 interviews, stopping upon reaching thematic saturation, with HIV-positive participants with a history of substance use who were enrolled in a longitudinal cohort study to assess the impact of prescribing changes among patients with chronic pain. Participants in this nested qualitative study had been reduced/discontinued from opioid pain relievers (OPRs) within the 12 months prior to interview. Interviews were audio-recorded and transcribed verbatim. Two analysts coded all interviews, interrater reliability was measured, and coding discrepancies discussed. The study took place in San Francisco, California in 2018. RESULTS Eleven participants were male with a mean age of 55; 8 were African American and 8 were White. All participants were HIV-positive, actively engaged in primary care, and had a lifetime history of illicit substance use. Twelve reported using illicit substances within the past year, including non-prescription opioids/heroin (10), and stimulant use (10). After being reduced/discontinued from their long-term opioid therapy, patients reported developing complex multimodal pain management systems that often included both nonpharmacological approaches and illicit substance use. Participants encountered a range of barriers to nonpharmacological therapies including issues related to accessibility and availability. Participants often reported attempts to replicate their prior OPR prescription by seeking out the same medication and dose from illicit sources and reported transitioning to heroin after exhausting other options. CONCLUSION After being reduced/discontinued from OPRs, HIV-positive patients with a history of substance use reported experimenting with a range of pain management modalities including nonpharmacological therapies and illicit substance use to manage symptoms of opioid withdrawal and pain. Providers should consider that any change to a patients' long-term opioid therapy may result in experimentation with pain management outside of the medical setting and may want to employ patient-centered, holistic approaches when managing patients' opioid prescriptions and chronic pain.
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Affiliation(s)
- Emily Behar
- San Francisco Department of Public Health, San Francisco, California, United States of America
- University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Rita Bagnulo
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Kelly Knight
- University of California, San Francisco, San Francisco, California, United States of America
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, San Francisco, California, United States of America
- University of California, San Francisco, San Francisco, California, United States of America
| | - Phillip O. Coffin
- San Francisco Department of Public Health, San Francisco, California, United States of America
- University of California, San Francisco, San Francisco, California, United States of America
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Nkhoma K, Ahmed A, Alli Z, Sherr L, Harding R. Is symptom prevalence and burden associated with HIV treatment status and disease stage among adult HIV outpatients in Kenya? A cross-sectional self-report study. AIDS Care 2019; 31:1461-1470. [PMID: 30913897 DOI: 10.1080/09540121.2019.1595514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
People with HIV experience a high prevalence and burden of physical and psychological symptoms throughout their disease trajectory. These have important public and clinical health implications. We aimed to measure: the seven-day period prevalence of symptoms, the most burdensome symptoms, and determine if self-reported symptom burden is associated with treatment status, clinical stage and physical performance. We conducted a cross-sectional study among adult (aged at least 18 years) patients with HIV, attending HIV outpatient care in Kenya. Data was gathered through self-report using the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), file extraction (sociodemographic data, treatment status, CD4 count, clinical stage) and through observation using the Karnofsky Performance Scale (KPS). Multivariable ordinal logistic regression assessed the association of symptom burden (MSAS-SF) controlling for demographic and clinical variables. Of the 475 participants approached, 400 (84.2%) participated. Ordinal logistic regression showed that being on HIV treatment was associated lower global distress index (in quartiles) (odds ratio .45, 95% CI .23 to .88; p = 0.019). Pain and symptom burden still persist in the era of antiretroviral therapy. Routine clinical practice should incorporate assessment and management of pain and symptoms irrespective of disease stage and treatment status in order to achieve the proposed fourth "90" in the UNAIDS 90-90-90 targets (that is good quality of life).
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Affiliation(s)
- Kennedy Nkhoma
- Faculty of Nursing Midwifery and Palliative Care, King's College London, Cicely Saunders Institute of Palliative Care Policy and Rehabilitation , London , UK
| | | | - Zipporah Alli
- Kenya Hospices and Palliative Care Association , Nairobi , Kenya
| | - Lorraine Sherr
- Institute for Global Health, University College London , London , UK
| | - Richard Harding
- Faculty of Nursing Midwifery and Palliative Care, King's College London, Cicely Saunders Institute of Palliative Care Policy and Rehabilitation , London , UK
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15
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LaRowe LR, Chilcott LN, Zvolensky MJ, Vanable PA, Flood K, Ditre JW. Associations between Pain-Related Anxiety, Gender, and Prescription Opioid Misuse among Tobacco Smokers Living with HIV/AIDS. Subst Use Misuse 2018; 53:2210-2219. [PMID: 29708450 PMCID: PMC6126665 DOI: 10.1080/10826084.2018.1464028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND People living with HIV/AIDS (PLWHA) who smoke cigarettes are vulnerable to greater pain and aberrant use of prescription pain medications. Prescription opioid misuse is highly prevalent among PLWHA and can lead to a variety of adverse outcomes. Pain-related anxiety, which has been implicated in the maintenance of both pain and tobacco dependence, may also play a role in prescription pain medication misuse. OBJECTIVES This study aimed to test associations between pain-related anxiety and prescription opioid misuse. We hypothesized that, among those prescribed opioid medication, pain-related anxiety would be positively associated with current opioid misuse, and stated intentions to misuse prescription opioids in the future. We further hypothesized that these relations would be more pronounced among males (vs. females). METHODS Participants included 61 PLWHA daily tobacco smokers with pain. Hierarchical regressions were used to test interactions between gender and pain-related anxiety on current and intended opioid misuse among those prescribed opioid medications. RESULTS There was a significant interactive effect of pain-related anxiety and gender on opioid misuse, such that pain-related anxiety was positively associated with current opioid misuse among male (but not female) participants who were prescribed opioid medications. Among both males and females, pain-related anxiety was positively associated with intention to misuse prescription pain medications in the future. Conclusions/Importance: Additional research into the role of pain-related anxiety in prescription opioid misuse is warranted. This type of work may inform the development of tailored interventions for PLWHA smokers who are prescribed opioid pain medications.
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Affiliation(s)
| | | | | | | | - Kelley Flood
- Immune Health Services, Upstate Medical University
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A Biopsychosocial Approach to Managing HIV-Related Pain and Associated Substance Abuse in Older Adults: a Review. AGEING INTERNATIONAL 2018. [DOI: 10.1007/s12126-018-9333-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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17
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Nkhoma K, Norton C, Sabin C, Winston A, Merlin J, Harding R. Self-management Interventions for Pain and Physical Symptoms Among People Living With HIV: A Systematic Review of the Evidence. J Acquir Immune Defic Syndr 2018; 79:206-225. [DOI: 10.1097/qai.0000000000001785] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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18
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Bruce RD, Merlin J, Lum PJ, Ahmed E, Alexander C, Corbett AH, Foley K, Leonard K, Treisman GJ, Selwyn P. 2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With HIV. Clin Infect Dis 2018; 65:e1-e37. [PMID: 29020263 DOI: 10.1093/cid/cix636] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/19/2017] [Indexed: 12/27/2022] Open
Abstract
Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population.It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- R Douglas Bruce
- Department of Medicine, Cornell Scott-Hill Health Center and Yale University, New Haven, Connecticut
| | - Jessica Merlin
- Divisions of Infectious Diseases and Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham
| | - Paula J Lum
- Division of HIV, Infectious Disease, and Global Medicine, University of California San Francisco
| | - Ebtesam Ahmed
- St. Johns University College of Pharmacy and Health Sciences, Metropolitan Jewish Health System Institute for Innovation in Palliative Care, New York
| | - Carla Alexander
- University of Maryland School of Medicine, Institute of Human Virology, Baltimore
| | - Amanda H Corbett
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Kathleen Foley
- Attending Neurologist Emeritus, Memorial Sloan Kettering Cancer Center, New York
| | - Kate Leonard
- Division of Neuroscience and Clinical Pharmacology, Cornell University, New York, New York
| | | | - Peter Selwyn
- Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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19
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deBoer H, Andrews M, Cudd S, Leung E, Petrie A, Chan Carusone S, O'Brien KK. Where and how does physical therapy fit? Integrating physical therapy into interprofessional HIV care. Disabil Rehabil 2018. [PMID: 29529881 DOI: 10.1080/09638288.2018.1448469] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose: To investigate the role of physical therapy in HIV care from the perspective of people living with HIV and health care professionals with expertise in HIV care. Methods: We conducted a qualitative descriptive study using semistructured interviews (with health care professionals) and focus groups (with people living with HIV). We purposively sampled health care professionals and recruited people living with HIV in collaboration with an HIV-specialty hospital. We asked participants about their knowledge of and experiences with physical therapy, and perceptions of the physical therapy role in interprofessional HIV care. We analyzed data using content analytical techniques. Results: Thirteen people living with HIV and 12 health care professionals conceptualized physical therapy as positively influencing independence and social participation, and as a valuable ally in interprofessional collaboration. The Framework of Physical Therapy Role in HIV Care consists of two components: (1) multidimensional and client-centered roles of physical therapy addressing physical, psychological and social health domains; and (2) contextual factors important to consider for the role of physical therapy: aging, episodic nature of HIV, multimorbidity, competing priorities, continuity of care, stigma, resource security and social isolation. The interaction between contextual factors and health domains can influence the role of physical therapy. Conclusion: The role of physical therapy in HIV is multidimensional and client-centered. This Framework can be used by rehabilitation professionals working with people living with HIV. Implications for Rehabilitation Participants living with HIV in this study experienced physical therapy as a means of addressing rehabilitation goals that positively influenced physical health and social participation. The role of physical therapy in HIV care is multidimensional and client-centered and can address health challenges in physical, social and psychological health domains. The presence and interaction of contextual factors including aging, episodic nature of HIV, multimorbidity, competing priorities, continuity of care, stigma, resource security and social isolation are important for clinicians to consider in order to optimize healthcare for people living with HIV. The Framework describing the role of physical therapy in HIV care can be used by rehabilitation professionals to help inform their approach for providing client-centered HIV care.
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Affiliation(s)
- Heather deBoer
- a Department of Physical Therapy , University of Toronto , Toronto , Canada
| | - Matthew Andrews
- a Department of Physical Therapy , University of Toronto , Toronto , Canada
| | - Stephanie Cudd
- a Department of Physical Therapy , University of Toronto , Toronto , Canada
| | - Ellie Leung
- a Department of Physical Therapy , University of Toronto , Toronto , Canada
| | - Alana Petrie
- a Department of Physical Therapy , University of Toronto , Toronto , Canada
| | | | - Kelly K O'Brien
- a Department of Physical Therapy , University of Toronto , Toronto , Canada.,c Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto , Canada.,d Rehabilitation Sciences Institute (RSI), University of Toronto , Toronto , Canada
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Edwards RR, Dworkin RH, Sullivan MD, Turk DC, Wasan AD. The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain. THE JOURNAL OF PAIN 2016; 17:T70-92. [PMID: 27586832 PMCID: PMC5012303 DOI: 10.1016/j.jpain.2016.01.001] [Citation(s) in RCA: 476] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/07/2015] [Accepted: 01/05/2016] [Indexed: 12/14/2022]
Abstract
UNLABELLED The recently proposed Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION)-American Pain Society (APS) Pain Taxonomy (AAPT) provides an evidence-based, multidimensional, chronic pain classification system. Psychosocial factors play a crucial role within several dimensions of the taxonomy. In this article, we discuss the evaluation of psychosocial factors that influence the diagnosis and trajectory of chronic pain disorders. We review studies in individuals with a variety of persistent pain conditions, and describe evidence that psychosocial variables play key roles in conferring risk for the development of pain, in shaping long-term pain-related adjustment, and in modulating pain treatment outcomes. We consider "general" psychosocial variables such as negative affect, childhood trauma, and social support, as well as "pain-specific" psychosocial variables that include pain-related catastrophizing, self-efficacy for managing pain, and pain-related coping. Collectively, the complexity and profound variability in chronic pain highlights the need to better understand the multidimensional array of interacting forces that determine the trajectory of chronic pain conditions. PERSPECTIVE The AAPT is an evidence-based chronic pain classification system in which psychosocial concepts and processes are essential in understanding the development of chronic pain and its effects. In this article we review psychosocial processes that influence the onset, exacerbation, and maintenance of chronic pain disorders.
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Affiliation(s)
- Robert R Edwards
- Department of Anesthesiology, Brigham & Women's Hospital and Harvard University, Boston, Massachusetts.
| | - Robert H Dworkin
- Departments of Anesthesiology and Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Ajay D Wasan
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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21
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Nkhoma K, Seymour J, Arthur A. An Educational Intervention to Reduce Pain and Improve Pain Management for Malawian People Living With HIV/AIDS and Their Family Carers: A Randomized Controlled Trial. J Pain Symptom Manage 2015; 50:80-90.e4. [PMID: 25666517 DOI: 10.1016/j.jpainsymman.2015.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/23/2014] [Accepted: 01/07/2015] [Indexed: 11/17/2022]
Abstract
CONTEXT Advances being made in improving access to HIV drugs in resource-poor countries mean HIV patients are living longer, and, therefore, experiencing pain over a longer period of time. There is a need to provide effective interventions for alleviating and managing pain. OBJECTIVES To assess whether a pain educational intervention compared with usual care reduces pain severity and improves pain management in patients with HIV/AIDS and their family carers. METHODS This was a randomized, parallel group, superiority trial conducted at HIV and palliative care clinics of two public hospitals in Malawi. A total of 182 adults with HIV/AIDS (Stage III or IV) and their family carers participated; carer participants were those individuals most involved in the patient's unpaid care. The educational intervention comprised a 30 minute face-to-face meeting, a leaflet, and a follow-up telephone call at two weeks. The content of the educational intervention covered definition, causes, and characteristics of pain in HIV/AIDS; beliefs and myths about pain and pain medication; assessment of pain; and pharmacological and nonpharmacological management. The primary outcome was average pain severity measured by the Brief Pain Inventory-Pain Severity subscale. Assessments were recorded at baseline before randomization and at eight weeks after randomization. RESULTS Of the 182 patient/carer dyads randomly allocated, 157 patient/carer dyads completed the trial. Patients in the intervention group experienced a greater decrease in pain severity (mean difference = 21.09 points, 95% confidence interval = 16.56-25.63; P < 0.001). CONCLUSION A short pain education intervention is effective in reducing pain and improving pain management for Malawian people living with HIV/AIDS and their family carers.
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Affiliation(s)
- Kennedy Nkhoma
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, Division of Nursing, Queen's Medical Centre, Nottingham, United Kingdom
| | - Jane Seymour
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, Division of Nursing, Queen's Medical Centre, Nottingham, United Kingdom.
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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Dageid W. Support groups for HIV-positive people in South Africa: who joins, who does not, and why? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 13:1-11. [PMID: 25174510 DOI: 10.2989/16085906.2014.886601] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Psychosocial health care for persons living with HIV/AIDS (PLWHA) is inadequate. Support groups for PLWHA could offer arenas where psychosocial issues are addressed, yet more knowledge is needed about those who join and those who do not join such groups. In this study, conducted in Limpopo province, South Africa, 49 PLWHA were asked about their motivations for joining a support group, while 22 PLWHA were asked about their reasons for not joining a support group. The most prevalent motivations for joining were to get information (59%) and social support (53%). The main reasons for not having joined were lack of knowledge (32%) and understanding (19%) about the support group and time constraints (19%). Physical symptoms and mental health were measured using the Stages of HIV Related Physical Symptoms & 20-item Symptom Checklist for HIV Infection and the General Health Questionnaire-28 (GHQ-28). Physical symptoms ranged from 0 to 17 with an average of 6. Mental distress was high, with 55% of members and 46% of non-members scoring above threshold levels. Support group members tended to be female, younger, to have tested due to pregnancy or out of concern, and to have grants as their sources of income. Non-members had tested due to illness, reported considerably more pain and were more likely to have no income. PLWHA experienced high mental, physical and social distress which must be addressed. Attention to gender differences is called for. While all members joined the support group to gain information and learn to cope, women were more likely to join to get support and deal with stress, while men joined to stay active and educate others. Support groups could be important links in the chain of comprehensive HIV health service delivery, given that they manage to recruit and meet the needs of PLWHA.
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Affiliation(s)
- Wenche Dageid
- a Department of Psychology , University of Oslo , Forskningsveien 3, PO Box 1094 Blindern, NO-0317 Oslo , Norway Author's
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Parker R, Stein DJ, Jelsma J. Pain in people living with HIV/AIDS: a systematic review. J Int AIDS Soc 2014; 17:18719. [PMID: 24560338 PMCID: PMC3929991 DOI: 10.7448/ias.17.1.18719] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 12/13/2013] [Accepted: 01/17/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Pain is one of the most commonly reported symptoms in people living with HIV/AIDS (PLWHA). However, wide ranges of pain prevalence have been reported, making it difficult to determine the relative impact of pain in PLWHA. A systematic review of the literature was conducted to establish the prevalence and characteristics of pain and to explore pain management in PLWHA. METHODS Studies that included cross-sectional data were included in the search, which was conducted in April 2012. Databases searched using a time limit of March 1982 to March 2012 included PubMed, Scopus, Africa-wide: NIPAD, CINAHL, PsychARTICLES, PSYCINFO, PSYCHIATRYONLINE, ScienceDirect and Web of Science. Search terms selected were "pain" and "HIV" or "acquired immune deficiency syndrome." Two reviewers independently screened all citation abstracts for inclusion. Methodological quality was evaluated using a standardized 11-item critical appraisal tool. RESULTS After full text review, 61 studies fulfilled the inclusion criteria. Prevalence of pain ranged from a point prevalence of 54% (95%CI 51.14-56.09) to 83% (95%CI 76-88) using a three-month recall period. The reported pain was of moderate-to-severe intensity, and pain was reported in one to two and a half different anatomical sites. Moderate levels of pain interference with function were reported. All nine studies reporting on the adequacy of pain management recorded marked under-treatment of pain. DISCUSSION The studies reviewed reported that pain commonly presents at multiple pain sites with a range of severity suggesting that there are several differing pathological processes contributing to pain at one time. The interplay of variables associated with pain suggests that the biopsychosocial model of pain is an appropriate paradigm from which to view pain in PLWHA and from which to approach the problem, explore causes and establish effective treatment. CONCLUSIONS The results highlight that pain is common in PLWHA at all stages of the disease. The prevalence rates for pain in PLWHA do not appear to have diminished over the 30 years spanning the studies reviewed. The body of work available in the literature thus far, while emphasizing the problem of pain, has not had an impact on its management.
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Affiliation(s)
- Romy Parker
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;
| | - Dan J Stein
- Department of Psychiatry & Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jennifer Jelsma
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Nkhoma K, Seymour J, Arthur A. An educational intervention to reduce pain and improve pain management for Malawian people living with HIV/AIDS and their family carers: study protocol for a randomised controlled trial. Trials 2013; 14:216. [PMID: 23849502 PMCID: PMC3717041 DOI: 10.1186/1745-6215-14-216] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022] Open
Abstract
Background Many HIV/AIDS patients experience pain often due to advanced HIV/AIDS infection and side effects of treatment. In sub-Saharan Africa, pain management for people with HIV/AIDS is suboptimal. With survival extended as a direct consequence of improved access to antiretroviral therapy, the prevalence of HIV/AIDS related pain is increasing. As most care is provided at home, the management of pain requires patient and family involvement. Pain education is an important aspect in the management of pain in HIV/AIDS patients. Studies of the effectiveness of pain education interventions for people with HIV/AIDS have been conducted almost exclusively in western countries. Methods/design A randomised controlled trial is being conducted at the HIV and palliative care clinics of two public hospitals in Malawi. To be eligible, patient participants must have a diagnosis of HIV/AIDS (stage III or IV). Carer participants must be the individual most involved in the patient’s unpaid care. Eligible participants are randomised to either: (1) a 30-minute face-to-face educational intervention covering pain assessment and management, augmented by a leaflet and follow-up telephone call at two weeks; or (2) usual care. Those allocated to the usual care group receive the educational intervention after follow-up assessments have been conducted (wait-list control group). The primary outcome is pain severity measured by the Brief Pain Inventory. Secondary outcomes are pain interference, patient knowledge of pain management, patient quality of life, carer knowledge of pain management, caregiver motivation and carer quality of life. Follow-up assessments are conducted eight weeks after randomisation by palliative care nurses blind to allocation. Discussion This randomised controlled trial conducted in sub-Saharan Africa among people living with HIV/AIDS and their carers will assess whether a pain education intervention is effective in reducing pain and improving pain management, quality of life and carer motivation. Trial registration Current Controlled Trials ISRCTN72861423.
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Affiliation(s)
- Kennedy Nkhoma
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Agreement between electronic medical record-based and self-administered pain numeric rating scale: clinical and research implications. Med Care 2013; 51:245-50. [PMID: 23222528 DOI: 10.1097/mlr.0b013e318277f1ad] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pain screening may improve the quality of care by identifying patients in need of further assessment and management. Many health care systems use the numeric rating scale (NRS) for pain screening, and record the score in the patients' electronic medical record (EMR). OBJECTIVE Determine the level of agreement between EMR and patient survey NRS, and whether discrepancies vary by demographic and clinical characteristics. METHODS We linked survey data from a sample of veterans receiving care in 8 Veterans Affairs medical facilities, to EMR data including an NRS collected on the day of the survey to compare responses to the NRS question from these 2 sources. We assessed correlation, agreement on clinical cut-points (eg, severe), and, using the survey as the gold standard, whether patient characteristics were associated with a discrepancy on moderate-severe pain. RESULTS A total of 1643 participants had a survey and EMR NRS score on the same day. The correlation was 0.56 (95% confidence interval, 0.52-0.59), but the mean EMR score was significantly lower than the survey score (1.72 vs. 2.79; P<0.0001). Agreement was moderate (κ=0.35). Characteristics associated with an increased odds of a discrepancy included: diabetes [adjusted odds ratio (AOR)=1.48], posttraumatic stress disorder (AOR=1.59), major depressive disorder (AOR=1.81), other race versus white (AOR=2.29), and facility in which care was received. CONCLUSIONS The underestimation of pain using EMR data, especially clinically actionable levels of pain, has important clinical and research implications. Improving the quality of pain care may require better screening.
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Merlin JS, Zinski A, Norton WE, Ritchie CS, Saag MS, Mugavero MJ, Treisman G, Hooten WM. A Conceptual Framework for Understanding Chronic Pain in Patients with HIV. Pain Pract 2013; 14:207-16. [DOI: 10.1111/papr.12052] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 01/05/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Jessica S. Merlin
- Division of Infectious Diseases, Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Anne Zinski
- Division of Infectious Diseases, Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Wynne E. Norton
- Department of Health Behavior; School of Public Health, University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Christine S. Ritchie
- Division of Geriatrics, Department of Medicine; University of California at San Francisco, Jewish Home of San Francisco Center for Research on Aging; San Francisco California U.S.A
| | - Michael S. Saag
- Division of Infectious Diseases, Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Michael J. Mugavero
- Division of Infectious Diseases, Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Glenn Treisman
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - W. Michael Hooten
- Department of Anesthesiology, Department of Psychiatry and Psychology; The Mayo Clinic; Rochester Minnesota U.S.A
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Receipt of opioid analgesics by HIV-infected and uninfected patients. J Gen Intern Med 2013; 28:82-90. [PMID: 22895747 PMCID: PMC3539026 DOI: 10.1007/s11606-012-2189-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/02/2012] [Accepted: 07/23/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Opioids are increasingly prescribed, but there are limited data on opioid receipt by HIV status. OBJECTIVES To describe patterns of opioid receipt by HIV status and the relationship between HIV status and receiving any, high-dose, and long-term opioids. DESIGN Cross-sectional analysis of the Veterans Aging Cohort Study. PARTICIPANTS HIV-infected (HIV+) patients receiving Veterans Health Administration care, and uninfected matched controls. MAIN MEASURES Pain-related diagnoses were determined using ICD-9 codes. Any opioid receipt was defined as at least one opioid prescription; high-dose was defined as an average daily dose ≥ 120 mg of morphine equivalents; long-term opioids was defined as ≥ 90 consecutive days, allowing a 30 day refill gap. Multivariable models were used to assess the relationship between HIV infection and the three outcomes. KEY RESULTS Among the HIV+ (n = 23,651) and uninfected (n = 55,097) patients, 31 % of HIV+ and 28 % of uninfected (p < 0.001) received opioids. Among patients receiving opioids, HIV+ patients were more likely to have an acute pain diagnosis (7 % vs. 4 %), but less likely to have a chronic pain diagnosis (53 % vs. 69 %). HIV+ patients received a higher mean daily morphine equivalent dose than uninfected patients (41 mg vs. 37 mg, p = 0.001) and were more likely to receive high-dose opioids (6 % vs. 5 %, p < 0.001). HIV+ patients received fewer days of opioids than uninfected patients (median 44 vs. 60, p < 0.001), and were less likely to receive long-term opioids (31 % vs. 34 %, p < 0.001). In multivariable analysis, HIV+ status was associated with receipt of any opioids (AOR 1.40, 95 % CI 1.35, 1.46) and high-dose opioids (AOR 1.22, 95 % CI 1.07, 1.39), but not long-term opioids (AOR 0.94, 95 % CI 0.88, 1.01). CONCLUSIONS Patients with HIV infection are more likely to be prescribed opioids than uninfected individuals, and there is a variable association with pain diagnoses. Efforts to standardize approaches to pain management may be warranted in this highly complex and vulnerable patient population.
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Silverberg MJ, Ray GT, Saunders K, Rutter CM, Campbell CI, Merrill JO, Sullivan MD, Banta-Green CJ, Von Korff M, Weisner C. Prescription long-term opioid use in HIV-infected patients. Clin J Pain 2012; 28:39-46. [PMID: 21677568 DOI: 10.1097/ajp.0b013e3182201a0f] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine changes the in use of prescription opioids for the management of chronic noncancer pain in human immunodeficiency virus (HIV)-infected patients and to identify patient characteristics associated with long-term use. METHODS Long-term prescription opioid use (ie, 120+ days supply or 10+ prescriptions during a year) was assessed between 1997 and 2005 among 6939 HIV-infected Kaiser Permanente members and HIV-uninfected persons in the general health plan memberships. RESULTS In 2005, 8% of HIV individuals had prevalent long-term opioid use, more than double the prevalence among HIV-uninfected individuals. However, the large increases in use from 1997 to 2005 in the general population were not observed for HIV-infected individuals. The strongest associations with prevalent use among HIV-infected individuals were female sex with a prevalence ratio (PR) of 1.8 (95% CI=1.3, 2.5); Charlson comorbidity score of 2 or more (compared with a score of 0) with a PR of 1.9 (95% CI=1.4, 2.8); injection drug use history with a PR of 1.8 (95% CI=1.3, 2.6); and substance use disorders with a PR of 1.8 (95% CI=1.3, 2.5). CD4, HIV viral load, and acquired immunodeficiency syndrome diagnoses were associated with prevalent opioid use early in the antiretroviral therapy era (1997), but not in 2005. CONCLUSIONS Long-term opioid use for chronic pain has remained stable over time for HIV patients, whereas its use increased in the general population. The prevalence of prescribed opioids in HIV patients was highest for certain subgroups, including women, and those with a comorbidity and substance abuse history.
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Kamerman PR, Mitchell D. Current perspectives on HIV-related pain and its management: insights from sub-Saharan Africa. Pain Manag 2011; 1:587-96. [DOI: 10.2217/pmt.11.65] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Sub-Saharan Africa is the region worst affected by the HIV epidemic and we estimate that at least 10 million HIV-positive individuals in sub-Saharan Africa live with significant pain related to their disease. Until recently there was a lack of studies specifically addressing pain related to HIV infection in sub-Saharan Africa, which limited our understanding of the scope of the problem. Here we describe the current nature of the epidemic of HIV-related pain in sub-Saharan Africa, including the systematic under-recognition and undertreatment of the pain.
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Affiliation(s)
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa
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Kowal J, Overduin LY, Balfour L, Tasca GA, Corace K, Cameron DW. The role of psychological and behavioral variables in quality of life and the experience of bodily pain among persons living with HIV. J Pain Symptom Manage 2008; 36:247-58. [PMID: 18411016 DOI: 10.1016/j.jpainsymman.2007.10.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 10/03/2007] [Accepted: 11/01/2007] [Indexed: 01/22/2023]
Abstract
With increased life expectancy of individuals living with HIV, quality of life (QOL) has become a focus of treatment. More research is needed to address pain-related QOL and modifiable variables, such as health behaviors, depressive symptoms, and coping styles, which could be included in treatment protocols to improve QOL among individuals with HIV. Objectives of this study were to (1) examine relationships among health behaviors, psychological variables, and QOL, particularly pain-specific QOL, (2) examine the relationships among coping, depressive symptoms, and QOL, and (3) compare QOL scores of individuals with HIV and population-based normative data. HIV positive men and women not currently on highly active antiretroviral therapy were recruited during regular visits to an HIV outpatient clinic. They completed the Medical Outcome Study Health Survey SF-36 scale, which includes a physical components scale, a mental components scale, and a bodily pain subscale. They also completed questionnaires assessing health behaviors, depressive symptoms, and coping styles. Participants (n=97) scored significantly lower on most aspects of QOL than age-matched Canadian and U.S. norms. Hierarchical multiple regressions revealed that physical activity and CD4 cell count were independently related to lower physical components scale scores; smoking and depressive symptoms were independently associated with lower mental components scale scores; and education, physical activity, and depressive symptoms were independently associated with lower pain-related QOL. Depressive symptoms mediated the relationship between coping styles and the mental components scale and pain-related QOL. Results suggest that targeting depressive symptoms, physical activity, and coping strategies as part of comprehensive treatment protocols could help improve pain-specific QOL and overall QOL among individuals with HIV.
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Affiliation(s)
- John Kowal
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Canada.
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Patel S, Weiss E, Chhabra R, Ryniker L, Adsuar R, Carness J, Kahalas W, DeLaMarter C, Feldman IS, Delorenzo JP, Tanner E, Rapkin B. The Events in Care Screening Questionnaire (ECSQ): a new tool to identify needs and concerns of people with HIV/AIDS. AIDS Patient Care STDS 2008; 22:381-93. [PMID: 18366327 DOI: 10.1089/apc.2007.0105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The purpose of this paper is to present validation data on the Events in Care Screening Questionnaire (ECSQ), which was designed to identify the needs and concerns of people living with HIV/AIDS (PLWHA) in nine specific domains: adherence to medical instructions; medical problems; specialty and inpatient hospital care; preventive health care and screening and behavioral health; sexual risk behavior; family planning; psychological symptoms; substance use; and life circumstances and demands. The ECSQ is the anchor for a more comprehensive measure called "The Dynamics of Care," and was administered in the context of a longitudinal study to evaluate New York State's HIV Special Needs Plan (HIV SNP), a Medicaid managed care model for PLWHA. Participants in the study, which began in March 2003 and closed recruitment in January 2007, were NYC PLWHA who were enrolled in either a Medicaid HIV SNP or Fee-For-Service plan. Participants were recruited through HIV SNP enrollment lists, direct on-site recruitment, and fliers. The specific event domains covered in the ECSQ were selected based on the purpose of the HIV SNP and the literature describing the needs and challenges that PLWHA face. Analyses are based on data from 628 study respondents over two times points. Results suggest that the concerns identified by PLWHA were largely consistent with their health care situation, heath status, risk behavior, and personal characteristics. Findings presented here lend support for the construct validity of the ECSQ and demonstrate its value as a starting point for inquiring more fully about the experiences of patients and improving the care they receive.
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Affiliation(s)
- Shilpa Patel
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Elisa Weiss
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Rosy Chhabra
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Laura Ryniker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Roberto Adsuar
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jason Carness
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Wendy Kahalas
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Carol DeLaMarter
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Ira S. Feldman
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Judy P. Delorenzo
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Ellen Tanner
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Bruce Rapkin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
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Larson MJ, Paasche-Orlow M, Cheng DM, Lloyd-Travaglini C, Saitz R, Samet JH. Persistent pain is associated with substance use after detoxification: a prospective cohort analysis. Addiction 2007; 102:752-60. [PMID: 17506152 DOI: 10.1111/j.1360-0443.2007.01759.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To test the hypothesis that persistent pain is associated with an increased odds of substance use after detoxification. DESIGN Analysis of data from a prospective cohort enrolled in a randomized controlled trial (RCT) to improve linkage with primary medical care. SETTING An urban residential detoxification program. PARTICIPANTS Adults (n = 397) enrolled in the RCT with heroin, alcohol or cocaine as a substance of choice and at least one follow-up interview. MEASUREMENTS The key independent variable was pain status: persistent pain (moderate to very severe pain at all available interviews), no pain (mild pain or less at all available interviews) and intermittent pain (all others). There were four outcomes of interest: self-reported use of any substance; heroin/opioid use; heavy alcohol use; and cocaine use 24 months after detoxification. Multivariable logistic regression controlled for several covariates including demographics, physical/sexual abuse, depressive symptoms, duration of follow-up and addiction severity at study entry. FINDINGS Pain in detoxification patients was common; 16% had persistent pain and 54% had intermittent pain. Persistent pain was associated with an increased odds for use of any substance [adjusted odds ratio (AOR) 4.2, 95% confidence interval (CI) 1.9-9.3], heroin/opioid use (AOR 5.4, 95% CI 2.1-13.8) and heavy alcohol use (AOR 2.2, 95% CI 1.0-4.5) at the 24-month follow-up. A statistically non-significant increase in the odds of cocaine use (AOR 2.0, 95% CI 0.9-4.6) was also observed. CONCLUSIONS Among individuals leaving residential detoxification, chronic pain is a common problem and is associated independently with long-term substance use after detoxification. Addressing pain as a treatable chronic condition among adults receiving detoxification presents a potential opportunity to improve long-term clinical outcomes and warrants further intervention research.
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Affiliation(s)
- Mary Jo Larson
- New England Research Institutes, Watertown, MA 02472, USA.
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Daniel HC, Van der Merwe JD. Chapter 58 Cognitive behavioral approaches and neuropathic pain. HANDBOOK OF CLINICAL NEUROLOGY 2006; 81:855-868. [PMID: 18808880 DOI: 10.1016/s0072-9752(06)80062-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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