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Cherenack EM, Stein MD, Abrantes AM, Busch A, Pinkston MM, Baker JV, Uebelacker LA. The relationship between substance use and physical activity among people living with HIV, chronic pain, and symptoms of depression: a cross-sectional analysis. AIDS Care 2023; 35:170-181. [PMID: 36260055 PMCID: PMC10038820 DOI: 10.1080/09540121.2022.2136349] [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: 07/23/2021] [Accepted: 10/11/2022] [Indexed: 10/24/2022]
Abstract
ABSTRACTChronic pain, depression, and substance use are common among people living with HIV (PLWH). Physical activity can improve pain and mental health. Some substances such as cannabis may alleviate pain, which may allow PLWH to participate in more physical activity. However, risks of substance use include poorer mental health and HIV clinical outcomes. This cross-sectional analysis examined the relationships of self-reported substance use (alcohol, cannabis, and nicotine use), gender, and age with self-reports of walking, moderate physical activity, and vigorous physical activity, converted to Metabolic Equivalent of Task Units (METs), among 187 adults living with HIV, chronic pain, and depressive symptoms in the United States. Women reported less walking, vigorous activity, and total physical activity compared to men. Individuals who used cannabis reported more vigorous physical activity relative to those who did not use cannabis. These findings were partially accounted for by substance use*gender interactions: men using cannabis reported more vigorous activity than all other groups, and women with alcohol use reported less walking than men with and without alcohol use. Research is needed to increase physical activity among women who use substances and to evaluate reasons for the relationship between substance use and physical activity among men.
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Affiliation(s)
- Emily M. Cherenack
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
| | - Michael D. Stein
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Ana M. Abrantes
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
| | - Andrew Busch
- Hennepin Healthcare, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Megan M. Pinkston
- Alpert Medical School of Brown University, Providence, RI, USA
- Lifespan Physicians Group, Miriam Hospital, Providence, RI, USA
| | - Jason V. Baker
- Hennepin Healthcare, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lisa A. Uebelacker
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
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2
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PULLEN SD, NUÑEZ MA, BENNETT S, BROWN W, CRONIN C, FLEISCHER M, MALCOLM A, RAMESH V, SPENCER K. Painful to Discuss: The Intersection of Chronic Pain, Mental Health, and Analgesic Use among People with HIV. JOURNAL OF AIDS AND HIV TREATMENT 2023; 5:46-53. [PMID: 38075387 PMCID: PMC10703349 DOI: 10.33696/aids.5.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
Objective This retrospective chart review study aims to identify patients in an HIV clinical setting in an area of high HIV prevalence in Atlanta, Georgia, USA who have chronic pain, analgesic prescriptions, and/or mental health diagnoses. Design People living with HIV (PLWH) are at higher risk for experiencing trauma, mental health conditions, and chronic pain than their HIV-negative counterparts. This study was designed to evaluate the intersection of these factors within an urban HIV clinic. Methods Retrospective chart review study. Results Of the adult patients enrolled at an HIV clinic in Atlanta, Georgia USA between 2011-2022 (n=15,970), 93.7% were prescribed analgesics, 40.5% had documented pain diagnoses, and 23.5% had documented mental health diagnoses. Additionally, 14.3% of all enrolled patients had all three factors concurrently. Conclusions The complexity of HIV, chronic pain, mental health challenges, and analgesic use demand a patient-centered, collaborative approach including a multidisciplinary care team. Seeing persistent pain among PLWH with a trauma-informed approach to care within the lens of co-occurring mental health diagnoses will allow us to better understand, treat, and sustain patients in life-saving HIV care.
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Affiliation(s)
- Sara D. PULLEN
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA 30322, USA
- Emory Center for AIDS Research, Atlanta, GA 30322, USA
| | - Maria Anjanette NUÑEZ
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA 30322, USA
| | - Sydney BENNETT
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA 30322, USA
| | - Wellsley BROWN
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA 30322, USA
| | - Catherine CRONIN
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA 30322, USA
| | - Maya FLEISCHER
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA 30322, USA
| | - Abigail MALCOLM
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA 30322, USA
| | - Vijay RAMESH
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA 30322, USA
| | - Kayla SPENCER
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA 30322, USA
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Cohen SP, Wang EJ, Doshi TL, Vase L, Cawcutt KA, Tontisirin N. Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies. BMJ MEDICINE 2022; 1:e000108. [PMID: 36936554 PMCID: PMC10012866 DOI: 10.1136/bmjmed-2021-000108] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/10/2022] [Indexed: 12/20/2022]
Abstract
Throughout human history, infection has been the leading cause of morbidity and mortality, with pain being one of the cardinal warning signs. However, in a substantial percentage of cases, pain can persist after resolution of acute illness, manifesting as neuropathic, nociplastic (eg, fibromyalgia, irritable bowel syndrome), or nociceptive pain. Mechanisms by which acute infectious pain becomes chronic are variable and can include immunological phenomena (eg, bystander activation, molecular mimicry), direct microbe invasion, central sensitization from physical or psychological triggers, and complications from treatment. Microbes resulting in a high incidence of chronic pain include bacteria such as the Borrelia species and Mycobacterium leprae, as well as viruses such as HIV, SARS-CoV-2 and herpeses. Emerging evidence also supports an infectious cause in a subset of patients with discogenic low back pain and inflammatory bowel disease. Although antimicrobial treatment might have a role in treating chronic pain states that involve active infectious inflammatory processes, their use in chronic pain conditions resulting from autoimmune mechanisms, central sensitization and irrevocable tissue (eg, arthropathy, vasculitis) or nerve injury, are likely to cause more harm than benefit. This review focuses on the relation between infection and chronic pain, with an emphasis on common viral and bacterial causes.
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tina L Doshi
- Departments of Anesthesiology & Critical Care Medicine and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lene Vase
- Department of Psychology, Aarhus University Hospital, Aarhus, Denmark
| | - Kelly A Cawcutt
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nuj Tontisirin
- Department of Anaesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, Mahidol University, Bangkok, Thailand
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Uebelacker LA, Cherenack EM, Busch A, Baker JV, Pinkston M, Gleason N, Madden S, Caviness CM, Stein MD. Pharmacologic and Non-Pharmacologic Treatments for Chronic Pain Used by Patients with Pain, HIV, and Depression. AIDS Behav 2022; 26:864-873. [PMID: 34468967 PMCID: PMC9125741 DOI: 10.1007/s10461-021-03447-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 12/29/2022]
Abstract
The objective of this study was to understand pain treatment utilization, perceived efficacy, and differences in utilization by gender, clinic site, chronicity of pain, pain severity, and depression severity among people living with HIV (PLWH), chronic pain, and elevated depression symptoms. Participants included 187 PLWH at three HIV clinics in the U.S. Overall, 85% of participants reported taking a pain medication. One quarter (25%) reported non-pharmacological professional treatments for pain (e.g., massage, physical therapy), 60% reported mind-body treatments, including exercise, meditation, and yoga, and 62% reported other non-pharmacological self-administered treatments (e.g., heat/cold). Most pain treatments were considered "slightly helpful" or "moderately helpful." Non-pharmacological self-administered treatments were more commonly used among women than men and among individuals with constant vs. intermittent pain. Further research is needed to evaluate the efficacy of the preferred analgesic modalities of PLWH.
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Affiliation(s)
- Lisa A Uebelacker
- Alpert Medical School of Brown University, Providence, RI, USA.
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA.
| | - Emily M Cherenack
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
| | - Andrew Busch
- Hennepin Healthcare, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jason V Baker
- Hennepin Healthcare, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Megan Pinkston
- Alpert Medical School of Brown University, Providence, RI, USA
- Miriam Hospital, Providence, RI, USA
| | | | | | - Celeste M Caviness
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
| | - Michael D Stein
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
- Boston University, Boston, MA, USA
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Brown-Taylor L, Beckner A, Scaff KE, Fritz JM, Buys MJ, Patel S, Bayless K, Brooke BS. Relationships between physical therapy intervention and opioid use: A scoping review. PM R 2021; 14:837-854. [PMID: 34153178 DOI: 10.1002/pmrj.12654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To synthesize available evidence that has examined the relationship between physical therapy (PT) and opioid use. TYPE: Scoping Review LITERATURE SURVEY: Data sources including Google Scholar, Embase, PubMed, Cochrane Library, and CINAHL were searched for English articles up to October 24, 2019 using terms ("physical therapy"[Title/Abstract] OR physiotherapy[Title/Abstract] OR rehabilitation[Title/Abstract]) AND (opiate*[Title/Abstract] OR opioid*[Title/Abstract]). METHODOLOGY Included studies evaluated a PT intervention and reported an opioid-use outcome. Data were extracted to describe the PT intervention, patient sample, opioid-use measurement, and results of any time or group comparisons. Study quality was evaluated with Joanna Briggs checklists based on study design. SYNTHESIS Thirty studies were included that evaluated PT in at least one of these seven categories: interdisciplinary program (n = 8), modalities (n = 3), treatment (n = 3), utilization (n = 2), content (n = 3), timing (n = 13), and location (n = 2). Mixed results were reported for reduced opioid-use after interdisciplinary care and after PT modalities. Utilizing PT was associated with lower odds (ranging from 0.2-0.8) of using opioid medication for persons with low back pain (LBP) and injured workers; however, guideline-adherent care did not further reduce opioid use for persons with LBP. Early PT utilization after index visit for spine or joint pain and after orthopedic surgery was also associated with lower odds of using opioid medications (ranging from 0.27-0.93). Emergency department PT care was not associated with fewer opioid prescriptions than standard emergency department care. PT in a rehabilitation center after total knee replacement was not associated with lower opioid use than inpatient PT. CONCLUSIONS The relationship between timing of PT and opioid use was evaluated in 13 of 30 studies for a variety of patient populations. Eight of these 13 studies reported a relationship between early PT and reduced subsequent opioid use, making the largest sample of studies in this scoping review with supporting evidence. There is limited and inconclusive evidence to establish whether the content and/or location of PT interventions improves outcomes because of heterogeneity between studies.
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Affiliation(s)
- Lindsey Brown-Taylor
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Medpace Inc., Cincinnati, Ohio, USA
| | - Aaron Beckner
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Ochsner Health System, New Orleans, Louisiana, USA
| | - Katie E Scaff
- Jonathan M. Wainwright Memorial VA Medical Center, Walla Walla, Washington, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Michael J Buys
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Department of Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Shardool Patel
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Department of Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Kim Bayless
- Department of Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Benjamin S Brooke
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Pullen S, Marconi VC, Del Rio C, Head C, Nimmo M, O'Neil J, Ziebart M. From Silos to Solidarity: Case Study of a Patient-Centered, Integrative Approach to Opioid Tapering and Chronic Pain Mitigation in a Multidisciplinary AIDS Clinic. JOURNAL OF AIDS AND HIV TREATMENT 2021; 3:4-11. [PMID: 34263265 PMCID: PMC8277158 DOI: 10.33696/aids.3.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: People with HIV (PWH) are at a disproportionate risk for experiencing both chronic pain and opioid use disorder (OUD). Prescription opioid tapering is typically addressed within the “silo model” of medical care, whereby attention is focused solely on opioid addiction rather than also addressing chronic pain management, and limited communication occurs between patient and providers. Objective: This descriptive case study examined an integrative, collaborative care model consisting of Provider, Physical Therapist (PT), and Patient aimed at decreasing chronic pain and opioid use within a multidisciplinary HIV/AIDS clinic. Method: A physical-therapy based model of chronic pain mitigation and physician-driven opioid tapering was implemented. The Provider, PT, and Patient worked collaboratively to address physiological pain, pain coping skills and opioid tapering. A patient case example was used to illustrate the implementation of the model for a future, larger study in the same patient population. Results: This model was feasible in this case example in terms of clinic workflow and acceptability to both the Patient and Providers in this clinic. After the intervention, the Patient’s pain was fully eliminated, and he had ceased all opioid use. Conclusion: Results of this case study suggest that utilizing an integrative, patient-centered approach to both chronic pain management and opioid tapering may be feasible within the context of a multidisciplinary HIV/AIDS clinic. Generalizability is limited by case study model; however, this gives insight into the value of a collaborative alternative compared to a “silo” model of opioid tapering and chronic pain management in preparation for a larger study.
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Affiliation(s)
- S Pullen
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - V C Marconi
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, United States.,Emory University Rollins School of Public Health, Department of Global Health, Atlanta, GA, United States
| | - C Del Rio
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, United States.,Emory University Rollins School of Public Health, Department of Global Health, Atlanta, GA, United States
| | - C Head
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - M Nimmo
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - J O'Neil
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - M Ziebart
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
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7
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Research Roundup - HIV and Chronic Pain: The Emerging Role of Physical Therapy. REHABILITATION ONCOLOGY 2021; 38:E41-E42. [PMID: 33447471 DOI: 10.1097/01.reo.0000000000000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pullen SD, Acker C, Kim H, Mullins M, Sims P, Strasbaugh H, Zimmerman S, del Rio C, Marconi VC. Physical Therapy for Chronic Pain Mitigation and Opioid Use Reduction Among People Living with Human Immunodeficiency Virus in Atlanta, GA: A Descriptive Case Series. AIDS Res Hum Retroviruses 2020; 36:670-675. [PMID: 32390457 DOI: 10.1089/aid.2020.0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
People living with HIV (PLH) may be at increased risk of experiencing both chronic pain and opioid dependence. Physical therapy (PT) has been shown to be effective as a nonpharmacological strategy for mitigating chronic pain in the general population, however, there is gap in research investigating PT to reduce chronic pain and opioid use among PLH. This case series describes the feasibility of an innovative PT intervention to decrease chronic pain and opioid use at a multidisciplinary human immunodeficiency virus (HIV) clinic. Participants (n = 4) were evaluated and given an individualized PT "package" consisting of manual therapy, exercise prescription, Transcutaneous Electrical Nerve Stimulation, and pain coping strategies. Pre- and postintervention outcomes were measured for pain reports, opioid use, and quality-of-life measures. After the intervention, all participants reported decrease or total elimination of both pain measured on the 0-10 numerical rating scale and opioid use measured in morphine milligram equivalents (MME). A paired t-test showed a significant difference (<.05) in the preintervention and postintervention pain scores and MME values. Results of this case series suggest in this sample that the described PT intervention is a feasible approach to mitigating chronic pain and opioid use among PLH and should be implemented on a larger scale for maximal effect.
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Affiliation(s)
- Sara D. Pullen
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christi Acker
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Haemi Kim
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Morgan Mullins
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Payton Sims
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Holly Strasbaugh
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samantha Zimmerman
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carlos del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Vincent C. Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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