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Liu X, Tang SJ. Pathogenic mechanisms of human immunodeficiency virus (HIV)-associated pain. Mol Psychiatry 2023; 28:3613-3624. [PMID: 37857809 DOI: 10.1038/s41380-023-02294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
Chronic pain is a prevalent neurological complication among individuals living with human immunodeficiency virus (PLHIV) in the post-combination antiretroviral therapy (cART) era. These individuals experience malfunction in various cellular and molecular pathways involved in pain transmission and modulation, including the neuropathology of the peripheral sensory neurons and neurodegeneration and neuroinflammation in the spinal dorsal horn. However, the underlying etiologies and mechanisms leading to pain pathogenesis are complex and not fully understood. In this review, we aim to summarize recent progress in this field. Specifically, we will begin by examining neuropathology in the pain pathways identified in PLHIV and discussing potential causes, including those directly related to HIV-1 infection and comorbidities, such as antiretroviral drug use. We will also explore findings from animal models that may provide insights into the molecular and cellular processes contributing to neuropathology and chronic pain associated with HIV infection. Emerging evidence suggests that viral proteins and/or antiretroviral drugs trigger a complex pathological cascade involving neurons, glia, and potentially non-neural cells, and that interactions between these cells play a critical role in the pathogenesis of HIV-associated pain.
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Affiliation(s)
- Xin Liu
- Stony Brook University Pain and Analgesia Research Center (SPARC), Stony Brook University, Stony Brook, 11794, NY, USA
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, 11794, NY, USA
| | - Shao-Jun Tang
- Stony Brook University Pain and Analgesia Research Center (SPARC), Stony Brook University, Stony Brook, 11794, NY, USA.
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, 11794, NY, USA.
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2
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Johnson SD, Fox HS, Buch S, Byrareddy SN. Chronic Opioid Administration is Associated with Prevotella-dominated Dysbiosis in SIVmac251 Infected, cART-treated Macaques. J Neuroimmune Pharmacol 2022; 17:3-14. [PMID: 33788119 PMCID: PMC9969301 DOI: 10.1007/s11481-021-09993-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 12/31/2022]
Abstract
People living with the human immunodeficiency virus (HIV) have an elevated risk of opioid misuse due to both prescriptions for HIV-associated chronic pain and because injection drug use remains a primary mode of HIV transmission. HIV pathogenesis is characterized by chronic immune activation and microbial dysbiosis, and translocation across the gut barrier exacerbating inflammation. Despite the high rate of co-occurrence, little is known about the microbiome during chronic opioid use in the context of HIV and combination antiretroviral therapy (cART). We recently demonstrated the reduction of the CD4 + T-cell reservoir in lymphoid tissues but increased in microglia/macrophage reservoirs in CNS by using morphine-treated, simian immunodeficiency virus (SIV)-infected rhesus macaques with viremia suppressed by cART. To understand whether morphine may perturb the gut-brain axis, fecal samples were collected at necropsy, DNA isolated, and 16S rRNA sequenced and changes of the microbiome analyzed. We found that morphine treatment led to dysbiosis, primarily characterized by expansion of Bacteroidetes, particularly Prevotellaceae, at the expense of Firmicutes and other members of healthy microbial communities resulting in a lower α-diversity. Of the many genera in Prevotellaceae, the differences between the saline and morphine group were primarily due to a higher relative abundance of Prevotella_9, the taxa most similar to Prevotella copri, an inflammatory pathobiont in the human microbiome. These findings reinforce previous research showing that opioid abuse is associated with dysbiosis, therefore, warranting additional future research to elucidate the complex interaction between the host and opioid abuse during HIV and SIV infection.
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Affiliation(s)
- Samuel D Johnson
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Howard S Fox
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shilpa Buch
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA.
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3
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Mills AR, Nichols MA, Davenport E. Chronic pain and medical cannabis: Narrative review and practice considerations in persons living with HIV. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Alex R. Mills
- School of Pharmacy University of Mississippi Jackson Mississippi USA
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4
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Mwesiga EK, Kaddumukasa M, Mugenyi L, Nakasujja N. Classification and description of chronic pain among HIV positive patients in Uganda. Afr Health Sci 2019; 19:1978-1987. [PMID: 31656480 PMCID: PMC6794538 DOI: 10.4314/ahs.v19i2.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic pain classification in HIV positive patients is essential for diagnosis and treatment. However, this is rarely done despite association with poor outcomes. METHODS A cross-sectional survey of 345 consented patients at a specialized HIV care center in Uganda was conducted. Chronic pain was defined as pain of more than two weeks duration. Data was collected using a socio-demographic questionnaire, the IASP classification of chronic pain; the StEP; Mini Mental Status Examination, Patient Health Questionnaire, Mini International Neuropsychiatric Interview and the World Health Organization quality of life instrument brief version. Chi-square, Fisher's exact, t-test and logistic regression analyses were carried out to determine factors associated with chronic pain. RESULTS Description of pain aetiology was difficult. Chronic pain was reported in 21.5% of the participants. Non-neuropathic (92.0%) was more common than neuropathic pain (8.0%). Chronic pain was found to be associated with feeling ill [OR=6.57 (3.48 - 12.39)], and worse scores in the quality of life domain for physical health [OR=0.71 (0.60 - 0.83)]. CONCLUSION People living with HIV/AIDS commonly have chronic pain that is associated with poor quality of life. More sensitive tools are needed to accurately describe chronic pain in resource limited settings.
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Affiliation(s)
| | - Mark Kaddumukasa
- Makerere University, College of Health Sciences, 7072 Kampala, Uganda
| | - Levicatus Mugenyi
- Infectious Disease Research Collaboration, Mulago Hill Road, MUJHU3 Building. P.O. Box 7475 Kampala, Uganda.
| | - Noeline Nakasujja
- Makerere University, College of Health Sciences, 7072 Kampala, Uganda.
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5
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Lira MC, Tsui JI, Liebschutz JM, Colasanti J, Root C, Cheng DM, Walley AY, Sullivan M, Shanahan C, O’Connor K, Abrams C, Forman LS, Chaisson C, Bridden C, Podolsky MC, Outlaw K, Harris CE, Armstrong WS, del Rio C, Samet JH. Study protocol for the targeting effective analgesia in clinics for HIV (TEACH) study - a cluster randomized controlled trial and parallel cohort to increase guideline concordant care for long-term opioid therapy among people living with HIV. HIV Res Clin Pract 2019; 20:48-63. [PMID: 31303143 PMCID: PMC6693587 DOI: 10.1080/15284336.2019.1627509] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/26/2019] [Accepted: 05/30/2019] [Indexed: 12/12/2022]
Abstract
Background: People living with HIV (PLWH) frequently experience chronic pain and receive long-term opioid therapy (LTOT). Adherence to opioid prescribing guidelines among their providers is suboptimal. Objective: This paper describes the protocol of a cluster randomized trial, targeting effective analgesia in clinics for HIV (TEACH), which tested a collaborative care intervention to increase guideline-concordant care for LTOT among PLWH. Methods: HIV physicians and advanced practice providers (n = 41) were recruited from September 2015 to December 2016 from two HIV clinics in Boston and Atlanta. Patients receiving LTOT from participating providers were enrolled through a waiver of informed consent (n = 187). After baseline assessment, providers were randomized to the control group or the year-long TEACH intervention involving: (1) a nurse care manager and electronic registry to assist with patient management; (2) opioid education and academic detailing; and (3) facilitated access to addiction specialists. Randomization was stratified by site and LTOT patient volume. Primary outcomes (≥2 urine drug tests, early refills, provider satisfaction) were collected at 12 months. In parallel, PLWH receiving LTOT (n = 170) were recruited into a longitudinal cohort at both clinics and underwent baseline and 12-month assessments. Secondary outcomes were obtained through patient self-report among participants enrolled in both the cohort and the RCT (n = 117). Conclusions: TEACH will report the effects of an intervention on opioid prescribing for chronic pain on both provider and patient-level outcomes. The results may inform delivery of care for PLWH on LTOT for chronic pain at a time when opioid practices are being questioned in the US.
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Affiliation(s)
- Marlene C. Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
| | - Judith I. Tsui
- Section of General Internal Medicine, Department of Medicine, University of Washington and Harborview Medical Center
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jonathan Colasanti
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Christin Root
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Debbie M. Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Alexander Y. Walley
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Meg Sullivan
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Christopher Shanahan
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Kristen O’Connor
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
| | - Catherine Abrams
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Leah S. Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Christine Chaisson
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Carly Bridden
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
| | - Melissa C. Podolsky
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
| | - Kishna Outlaw
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Catherine E. Harris
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Carlos del Rio
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jeffrey H. Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
- Department of Medicine, Boston University School of Medicine, Boston, MA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
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Guindon J, Blanton H, Brauman S, Donckels K, Narasimhan M, Benamar K. Sex Differences in a Rodent Model of HIV-1-Associated Neuropathic Pain. Int J Mol Sci 2019; 20:ijms20051196. [PMID: 30857270 PMCID: PMC6429465 DOI: 10.3390/ijms20051196] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/25/2019] [Accepted: 03/05/2019] [Indexed: 12/25/2022] Open
Abstract
Worldwide, women account for approximately 51% of human immunodeficiency virus-1 (HIV) seropositive individuals. The prevalence of neuropathic pain among individuals with HIV and a lack of preclinical data characterizing sex differences prompted us to address this knowledge gap. C57BL/6 male and female mice received multiple intrathecal injections of HIV-glycoprotein 120 (gp120), followed by determination of mechanical allodynia and thermal hypersensitivity for four weeks. The influence of ovarian hormones in the gp120 pain model was evaluated by comparison of ovariectomized (OVX) mice versus sham control. We found that gp120-induced neuropathic pain-like behaviors are sex-dependent. Female mice showed both increased mechanical allodynia and increased cold sensitivity relative to their male counterparts. The OVX mice showed reduced pain sensitivity compared to sham, suggesting a role of the ovarian hormones in sex differences in pain sensitivity to gp120. Gp120-induced neuropathic pain caused a shift in estrous cycle toward the estrus phase. However, there is a lack of clear correlation between the estrous cycle and the development of neuropathic pain-like behaviors during the four week recording period. This data provided the first evidence for sex differences in a rodent model of HIV-related neuropathic pain, along with a potential role of ovarian hormones.
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Affiliation(s)
- Josée Guindon
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, School of Medicine Lubbock, Lubbock, TX 79430, USA.
| | - Henry Blanton
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, School of Medicine Lubbock, Lubbock, TX 79430, USA.
| | - Seth Brauman
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, School of Medicine Lubbock, Lubbock, TX 79430, USA.
| | - Kelsey Donckels
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, School of Medicine Lubbock, Lubbock, TX 79430, USA.
| | - Madhusudhanan Narasimhan
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, School of Medicine Lubbock, Lubbock, TX 79430, USA.
| | - Khalid Benamar
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, School of Medicine Lubbock, Lubbock, TX 79430, USA.
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Frequent Occurrence of Pain and Prescription Opioid Use for Treatment of Pain Among Women with and at Risk for HIV Infection. AIDS Behav 2018. [PMID: 28631227 DOI: 10.1007/s10461-017-1828-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pain is frequent and underreported among HIV+ women. We determined occurrence and severity of pain, and types of pain treatments used among HIV+ and HIV- women. Cross-sectional analyses of pain as measured by the Brief Pain Inventory Short Form, and related pain therapies nested in the Women's Interagency HIV Study (WIHS). Multiple variable linear regression models examined differences by HIV status in pain severity and pain interference in general activity, mood, ability to walk, work, relationships with others, sleep, and enjoyment of life. Among 1393 HIV+ and 587 HIV- participants with median age 47-48 years, there was no statistically significant difference in pain reported within the past week by HIV status (HIV+ 50% vs. 49% HIV-, p = 0.70). Ratings of pain severity and interference were similar between HIV+ and HIV- women, as was receipt of pain medication (58% HIV+ vs. 56% HIV-). Pain medications most frequently used were: NSAIDS (90% HIV+, 96% HIV-), opioids (65% HIV+, 67% HIV-), topical anesthetics (46% HIV+, 56% HIV-), muscle relaxants (23% HIV+, 14% HIV-), and anticonvulsants (23% HIV+, 14% HIV-). Nearly half of predominantly low income, minority women reported pain in the past week, and two-thirds reported opioid use for pain management. The occurrence, severity, and treatment of pain did not differ by HIV status, nor did report of pain interference with mood or function. Additional research is needed to better characterize pain etiology among HIV+ women in the era of potent antiretroviral therapy, and determine the extent to which pain severity and type of medication used for pain treatment impact HIV disease outcomes.
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8
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Shim EJ, Ha H, Lee SH, Kim NJ, Kim ES, Bang JH, Song KH, Sohn BK, Park HY, Son KL, Hwang H, Lee KM, Hahm BJ. Psychometric properties of the Korean version of the medical outcomes study HIV health survey: results from a multicenter survey in Korea. Health Qual Life Outcomes 2018; 16:92. [PMID: 29764440 PMCID: PMC5952830 DOI: 10.1186/s12955-018-0919-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/30/2018] [Indexed: 01/13/2023] Open
Abstract
Background Precise assessment of health-related quality of life (HRQOL) with a reliable and valid measure is a prerequisite to the enhancement of HRQOL. This study examined the psychometric properties of the Korean version of the Medical Outcomes Study HIV Health Survey (K-MOS-HIV). Methods The reliability and validity of the K-MOS-HIV were examined in a multicenter survey involving 201 outpatients with human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) from four teaching hospitals throughout Korea. Results Ceiling effects were observed in six subscales scores, particularly, for the role functioning (71.1%), social functioning (63.2%), and pain (48.8%) scores. The Cronbach’s α for the physical health summary and mental health summary were 0.90 and 0.94, respectively, and it ranged from 0.78 to 0.95 for the subscales. The results of the exploratory structural equation modeling supported the two-factor structure of the K-MOS-HIV (physical health summary and mental health summary). An examination of the mean square statistics values from the Rasch analysis showed that the information-weighted fit and outlier-sensitive fit statistics were within the acceptable ranges of 0.6–1.4 except for two items in the mental health summary. The convergent validity of the K-MOS-HIV was supported by its significant positive correlations with the World Health Organization Quality of Life-HIV-BREF subscale scores. Its known-group validity was proven with its ability to detect significant differences in several K-MOS-HIV subscale scores among participants with different sociodemographic and clinical characteristics. Conclusions The K-MOS-HIV health survey appears to be a reliable and valid measure of HRQOL.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Hyeju Ha
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Bo Kyung Sohn
- Department of Psychiatry, Sanggye Paik Hospital, Seoul, South Korea.,Department of Psychiatry, Inje University College of Medicine, Busan, Republic of Korea
| | - Hye Youn Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyung-Lak Son
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heesung Hwang
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Min Lee
- Public Health and Medical Service, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bong-Jin Hahm
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
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9
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Wong CCY, Paulus DJ, Lemaire C, Leonard A, Sharp C, Neighbors C, Brandt CP, Lu Q, Zvolensky MJ. Examining HIV-Related stigma in relation to pain interference and psychological inflexibility among persons living with HIV/AIDS: The role of anxiety sensitivity. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2018; 17:1-15. [PMID: 30034300 PMCID: PMC6051718 DOI: 10.1080/15381501.2017.1370680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Pain is highly prevalent among people living with HIV (PLHIV). Although the association between stigma and pain among stigmatized individuals has been well-established in the non- HIV chronic pain literature, little is known about the association between stigma and pain among PLHIV and the mechanisms that underlie this association. The present study examined the indirect effect of HIV stigma and pain via anxiety sensitivity (fear of anxiety symptoms). The sample included 97 PLHIV (60.2% male, Mage = 48.40, SD = 7.75). Results indicated significant and medium-sized indirect effects of HIV stigma on pain severity, pain interference, and psychological inflexibility in pain via anxiety sensitivity. Alternative models did not yield significant indirect effects. The results suggest anxiety sensitivity may explain the association between stigma and pain among PLHIV. These findings provide novel empirical insight into the nature of stigma-pain relation among PLHIV and could be used to guide pain-based intervention development for this population.
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Affiliation(s)
- Celia C. Y. Wong
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Daniel J. Paulus
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Amy Leonard
- Legacy Community Healthcare, Houston, TX, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Charles P. Brandt
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Qian Lu
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Abstract
We analyzed baseline data from an observational cohort of HIV-infected ART-naïve patients in St. Petersburg, Russia to explore whether pain was associated with HIV risk behaviors. The primary outcomes were (1) unprotected vaginal or anal sex in the past 90 days and (2) sharing of needles or equipment in the past month. Secondary outcomes included: use of alcohol prior to sex, current injection drug use, number of unprotected sex and sharing episodes, and days injected in the past month. The main independent variable was any past week pain. Multivariable regression models were fit for outcomes. After adjustment, the association with unprotected sex was of borderline significance (AOR = 2.06; 95 % CI 0.98-4.36, p = 0.058); there was no significant association between any past week pain and sharing of needles/equipment (AOR = 1.52; 95 % CI 0.65-3.59, p = 0.33). Participants with pain had higher odds of reporting alcohol use prior to sex (AOR = 2.42; 95 % CI 1.10-5.28, p = 0.03).
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11
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Dahlman D, Kral AH, Wenger L, Hakansson A, Novak SP. Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:29. [PMID: 28558841 PMCID: PMC5450090 DOI: 10.1186/s13011-017-0112-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/19/2017] [Indexed: 11/20/2022]
Abstract
Background People who inject drugs (PWID) often have poor health and lack access to health care. The aim of this study was to examine whether PWID engage in self-treatment through nonmedical prescription opioid use (NMPOU). We describe the prevalence and features of self-reported physical pain and its association with NMPOU. Methods PWID (N = 702) in San Francisco, California (age 18+) were recruited to complete interviewer administered surveys between 2011 and 2013. Multivariate logistic regression analysis was conducted to examine the associations among self-reported pain dimensions (past 24-h average pain, pain interference with functional domains) and NMPOU, controlling for age, sex, psychiatric illness, opioid substitution treatment, homelessness, street heroin use and unmet healthcare needs. Results Almost half of the sample reported pain, based on self-reported measures in the 24 h before their interview. The most common pain locations were to their back and lower extremities. Past 24-h NMPOU was common (14.7%) and associated with past 24 h average pain intensity on a 10 point self-rating scale (adjusted odds ratio [AOR] = 2.15, 95% confidence interval [CI] 1.21–3.80), and past 24 h pain interference with general activity (AOR 1.82 [95% CI 1.04–3.21]), walking ability (AOR 2.52 [95% CI 1.37–4.63]), physical ability (AOR 2.01 [95% CI 1.16–3.45]), sleep (AOR 1.98 [95% CI 1.13–3.48]) and enjoyment of life (AOR 1.79 [95% CI 1.02–3.15]). Conclusion Both pain and NMPOU are common among PWID, and highly correlated in this study. These findings suggest that greater efforts are needed to direct preventive health and services toward this population.
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Affiliation(s)
- Disa Dahlman
- Department of Clinical Sciences Lund, Division of Psychiatry, Lund University, Lund, Sweden. .,Malmo Addiction Centre, Clinical Research Unit, Sodra Forstadsg. 35, plan 4, SE-205 02, Malmo, Sweden.
| | - Alex H Kral
- Behavioral and Urban Health Program, RTI International, San Francisco, USA
| | - Lynn Wenger
- Behavioral and Urban Health Program, RTI International, San Francisco, USA
| | - Anders Hakansson
- Department of Clinical Sciences Lund, Division of Psychiatry, Lund University, Lund, Sweden.,Malmo Addiction Centre, Clinical Research Unit, Sodra Forstadsg. 35, plan 4, SE-205 02, Malmo, Sweden
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12
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Tsui JI, Cheng DM, Quinn E, Bridden C, Merlin JS, Saitz R, Samet JH. Pain and Mortality Risk in a Cohort of HIV-Infected Persons with Alcohol Use Disorders. AIDS Behav 2016; 20:583-9. [PMID: 26438486 DOI: 10.1007/s10461-015-1206-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pain has been associated with increased risk for mortality in some studies. We analyzed data from a cohort study [HIV-longitudinal interrelationships of viruses and ethanol (HIV-LIVE)] of HIV-infected persons with alcohol use disorders enrolled 2001-2003 to explore whether reporting moderate or greater pain interference was associated with mortality. The main independent variable was pain that at least moderately interfered with work based on a single question from the SF-12. Primary analyses dichotomized at "moderately" or above. Cox proportional hazards models assessed the association between pain interference and death adjusting for demographics, substance use, CD4 count, HIV viral load and co-morbidities. Although significant in unadjusted models (HR = 1.58 (95 % CI 1.03-2.41; p value = 0.04)), after adjusting for confounders, ≥moderate pain interference was not associated with an increased risk of death [aHR = 1.30 (95 % CI 0.81-2.11, p value = 0.28)]. Among HIV-infected persons with alcohol use disorders, we did not detect a statistically significant independent association between pain interference and risk of death after adjustment for potential confounders.
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13
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Mwesiga EK, Mugenyi L, Nakasujja N, Moore S, Kaddumukasa M, Sajatovic M. Depression with pain co morbidity effect on quality of life among HIV positive patients in Uganda: a cross sectional study. Health Qual Life Outcomes 2015; 13:206. [PMID: 26718268 PMCID: PMC4697332 DOI: 10.1186/s12955-015-0403-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/23/2015] [Indexed: 11/20/2022] Open
Abstract
Background Depression with pain comorbidity (DPC) has not been clearly defined among HIV positive patients in sub-Saharan Africa. It still remains a challenge despite many studies in Africa documenting a high prevalence of pain and depression among people living with HIV/AIDS. Both are associated with a grave impact on the health related outcomes in this pandemic. This study aimed at determining the prevalence, factors associated and effect on quality of life of DPC among HIV positive patients. Methods In a cross-sectional survey, 345 HIV positive patients were enrolled into the study. Using a pre-tested standardised questionnaire the presence of DPC was assessed after a written informed consent. The associations between DPC, quality of life, depression history, severity, and cognition were determined. A p-value of <0.05 was considered to be significant. Results Among people living with HIV/AIDS (PLWHA), the prevalence of DPC was about 5 %. PLWHA with DPC were more likely to perceive their overall quality of life as poor and scored poorly in all the domains on the WHOQOL-BREF. They were also more likely to have more severe forms of depression and recurrent episodes of depression. Conclusions DPC is common, under diagnosed and undertreated in PLWHA in Uganda. Depression and pain screening as well as appropriate access to care for DPC have potential to improve quality of life and health outcomes. This calls for the integration and training of mental health services into HIV/AIDS care and future efforts by policy makers and HIV caregivers to address this treatment gap to advance the care of people living with HIV in Uganda.
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Affiliation(s)
| | - Levi Mugenyi
- Infectious Disease Research Collaboration, Mulago Hill Road, MUJHU3 Building, P.O. Box 7475, Kampala, Uganda
| | - Noeline Nakasujja
- College of Health Sciences, Makerere University, 7072, Kampala, Uganda
| | - Shirley Moore
- Neurological and Behavioral Outcomes Center, University Hospital Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Mark Kaddumukasa
- College of Health Sciences, Makerere University, 7072, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospital Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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Is HIV Painful? An Epidemiologic Study of the Prevalence and Risk Factors for Pain in HIV-infected Patients. Clin J Pain 2015; 31:813-819. [PMID: 25329144 DOI: 10.1097/ajp.0000000000000162] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the prevalence, impact, and risk factors for pain among a cohort of human immunodeficiency virus (HIV)-infected adults treated with combination antiretroviral therapy if indicated according to current guidelines. METHODS This was a cross-sectional epidemiological observational study. All patients attending 1 HIV-outpatient center in the United Kingdom in a 10-month period were eligible. Patients completed a validated questionnaire enquiring about demographics, HIV factors, and symptoms of pain. RESULTS Of 1050 eligible participants, 859 (82%) completed a questionnaire. The 1-month period prevalence of pain lasting >1 day was 62.8% among whom 63% reported current pain. The prevalence of pain at most anatomic sites was broadly similar to that observed in population studies using the same questionnaires except that we found considerably higher rates of foot/ankle pain. The median duration of pain was 3 years (range, 0 to 51 y) and the median pain score was 5.0 on an 11-point visual analogue score. Over 40% of people in pain had consulted their primary care physician and >20% were taking analgesics daily. Independent risk factors for current pain were older age (P=0.001), time since diagnosis of HIV infection (P=0.001), and receipt of a protease inhibitor-based regimen (P=0.04). DISCUSSION Pain, and notably foot/ankle pain, is common among adults living with prevalent HIV and is associated with substantial morbidity and health care utilization.
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Kowalski M, Firląg-Burkacka E, Horban A. The occurrence and characteristics of pain in HIV-1 positive persons – A challenge in the aging population. HIV & AIDS REVIEW 2015. [DOI: 10.1016/j.hivar.2015.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Voon P, Callon C, Nguyen P, Dobrer S, Montaner JSG, Wood E, Kerr T. Denial of prescription analgesia among people who inject drugs in a Canadian setting. Drug Alcohol Rev 2014; 34:221-8. [PMID: 25521168 DOI: 10.1111/dar.12226] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 10/05/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND AIMS Despite the high prevalence of pain among people who inject drugs (PWIDs), clinicians may be reluctant to prescribe opioid-based analgesia to those with a history of drug use or addiction. We sought to examine the prevalence and correlates of PWIDs reporting being denied of prescription analgesia (PA). We also explored reported reasons for and actions taken after being denied PA. DESIGN AND METHODS Using data from two prospective cohort studies of PWIDs, multivariate logistic regression was used to identify the prevalence and correlates of reporting being denied PA. Descriptive statistics were used to characterise reasons for denials and subsequent actions. RESULTS Approximately two-thirds (66.5%) of our sample of 462 active PWIDs reported having ever been denied PA. We found that reporting being denied PA was significantly and positively associated with having ever been enrolled in methadone maintenance treatment (adjusted odds ratio 1.76, 95% confidence interval 1.11-2.80) and daily cocaine injection (adjusted odds ratio 2.38, 95% confidence interval 1.00-5.66). The most commonly reported reason for being denied PA was being accused of drug seeking (44.0%). Commonly reported actions taken after being denied PA included buying the requested medication off the street (40.1%) or obtaining heroin to treat pain (32.9%). DISCUSSION AND CONCLUSIONS These findings highlight the challenges of addressing perceived pain and the need for strategies to prevent high-risk methods of self-managing pain, such as obtaining diverted medications or illicit substances for pain. Such strategies may include integrated pain management guidelines within methadone maintenance treatment and other substance use treatment programs.
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Affiliation(s)
- Pauline Voon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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17
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Pain is associated with risky drinking over time among HIV-infected persons in St. Petersburg, Russia. Drug Alcohol Depend 2014; 144:87-92. [PMID: 25220898 PMCID: PMC4252482 DOI: 10.1016/j.drugalcdep.2014.08.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pain is highly prevalent among persons with HIV. Alcohol may be used to "self-medicate" pain. This study examined the association between pain and risky alcohol use over time in a cohort of HIV-infected Russian drinkers. METHODS This secondary analysis utilized longitudinal data from a randomized trial of a behavioral intervention. Subjects included HIV-infected adults who reported past 6-month risky drinking and unprotected sex and were recruited from HIV and addiction treatment sites in St. Petersburg, Russia. The main independent variable was pain that at least moderately interfered with daily living. The primary outcome was past month risky drinking amounts based on NIAAA guidelines. General estimating equations (GEE) logistic regression models were used to calculate odds ratios and 95% confidence intervals for the association between pain and risky drinking over time (i.e., baseline, 6 and 12 months), adjusting for potential confounders. RESULTS Baseline characteristics of participants (n=699) were mean age of 30 (SD ±5) years, 41% female, and 22% <9th grade education. Nearly one quarter (24%) had a CD4 cell count <200 cells/μl, and only 17% were on antiretroviral therapy. Nearly half (46%) reported at least moderate pain interference in the past month and 81% were drinking risky amounts. In adjusted longitudinal GEE models, pain was significantly associated with greater odds of reporting past month risky drinking (AOR = 1.34, 95% CI: 1.05-1.71, p value=0.02). CONCLUSIONS Among a cohort of HIV-infected Russian drinkers, pain that at least moderately interfered with daily living was associated with higher odds of reporting risky drinking amounts over time.
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18
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Narasimooloo C, Naidoo SS, Gaede BM. Adequacy of pain management in HIV-positive patients. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2011.10874063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- C Narasimooloo
- Department of Family Medicine, UKZN, Durban, South Africa
- McCord Hospital, Durban, South Africa
| | - SS Naidoo
- McCord Hospital, Durban, South Africa
| | - BM Gaede
- Emmaus Hospital, Winterton, KwaZulu-Natal, South Africa
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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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Tsui JI, Cheng DM, Coleman SM, Blokhina E, Bridden C, Krupitsky E, Samet JH. Pain is associated with heroin use over time in HIV-infected Russian drinkers. Addiction 2013; 108:1779-87. [PMID: 23773361 PMCID: PMC4012755 DOI: 10.1111/add.12274] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate whether pain was associated with increased risk of using heroin, stimulants or cannabis among HIV-infected drinkers in Russia. DESIGN Secondary analysis of longitudinal data from the HERMITAGE study (HIV's Evolution in Russia-Mitigating Infection Transmission and Alcoholism in a Growing Epidemic), a behavioral randomized controlled trial, with data collected at baseline, 6-month and 12-month visits. SETTING Recruitment occurred at HIV and addiction treatment sites in St Petersburg, Russian Federation. PARTICIPANTS Six hundred and ninety-nine HIV-infected adult drinkers. MEASUREMENTS The primary outcome was past month illicit drug use; secondary outcomes examined each drug (heroin, stimulants and cannabis) separately. The main predictor was pain that interfered at least moderately with daily living. General estimating equations (GEE) logistic regression models were used to evaluate the association between pain and subsequent illicit drug use, adjusting for potential confounders. FINDINGS Participants reporting pain appeared to have higher odds of using illicit drugs, although the results did not reach statistical significance [adjusted odds ratio (OR) = 1.32; 95% confidence interval (CI) = 0.99, 1.76, P = 0.06]. There was a significant association between pain and heroin use (OR = 1.54; 95% CI = 1.11-2.15, P = 0.01) but not use of other drugs (OR = 0.75; 95% CI =0.40-1.40, P = 0.35 for stimulants and OR = 0.70; 95% CI = 0.45-1.07, P = 0.09 for cannabis). CONCLUSIONS HIV-infected Russian drinkers who report pain are more likely to use heroin over time than HIV-infected Russian drinkers who do not report pain. Pain may be an unrecognized risk factor for persistent heroin use with implications for HIV transmission in Russia.
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Affiliation(s)
- Judith I. Tsui
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA
| | - Debbie M. Cheng
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA,Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave., 3 Floor, Boston, MA 02118-2605, USA
| | - Sharon M. Coleman
- Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Ave., 3 Floor, Boston, MA 02118-2605, USA
| | - Elena Blokhina
- Institute of Pharmacology, St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russia
| | - Carly Bridden
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA
| | - Evgeny Krupitsky
- Laboratory of Clinical Pharmacology of Addictions, St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russia,Department of Addictions, Bekhterev Research Psychoneurological Institute, Bekhtereva St., 3, St. Petersburg 192019, Russia
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA,Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118-2605, USA
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21
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Ebirim LN, Otokwala JG. Inadequate pain relief in ambulatory patients with human immunodeficiency virus disease in Port Harcourt. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2013; 5:199-203. [PMID: 23976866 PMCID: PMC3746733 DOI: 10.2147/hiv.s45150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To estimate the prevalence of pain in ambulatory patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in Port Harcourt and to determine the type, site, severity, and adequacy of the treatment of pain in these patients. MATERIALS AND METHODS A cross-sectional survey was carried out at two antiretroviral therapy centers in Port Harcourt, Nigeria. A data sheet, the brief pain inventory, and the short form of the McGill pain questionnaire were used and 157 patients in various stages of HIV/AIDS participated in the study. RESULTS About 83.7% (129/157) of the ambulatory patients with HIV/AIDS complained of pains. Of the patients who reported pain 61.24% (79/129) reported nociceptive pain while 38.76% (50/129) reported neuropathic pain. Chest pain was the most frequent site of pain followed by headache. About 82% (106/129) of those who complained of pain received some form of analgesic, but only 23.58% (25/106) of these obtained adequate pain relief. The majority of the participants had significant impairment of their quality of life due to the severity of their pain. CONCLUSION Pain associated with significant impairment of quality of life is common in ambulatory patients with HIV/AIDS in Port Harcourt. Whereas the majority of the patients used various pain relief methods, analgesia was inadequate.
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Affiliation(s)
- Longinus Ndubuisi Ebirim
- Department of Anaesthesiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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22
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Namisango E, Harding R, Atuhaire L, Ddungu H, Katabira E, Muwanika FR, Powell RA. Pain among ambulatory HIV/AIDS patients: multicenter study of prevalence, intensity, associated factors, and effect. THE JOURNAL OF PAIN 2012; 13:704-13. [PMID: 22748803 DOI: 10.1016/j.jpain.2012.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/05/2012] [Accepted: 04/30/2012] [Indexed: 12/01/2022]
Abstract
UNLABELLED This study aimed to determine the prevalence, intensity, associated factors, and effect of pain among ambulatory HIV/AIDS patients. Three-hundred two adult ambulatory HIV/AIDS patients were consecutively recruited from HIV/AIDS outpatient clinics at 2 teaching hospitals in Uganda. The presence and intensity of pain were self-reported using the Brief Pain Inventory (BPI); symptom data were collected using the Memorial Symptom Assessment Scale (MSAS-SF); and quality of life (QOL) was assessed using the Medical Outcome Scale-HIV. Forty-seven percent reported pain in the 7 days prior to the survey and pain was a symptom at the time of diagnosis for 68%. On the 0 to 10 numeric scale, 53% reported mild pain (1-4 rating), 20% reported moderate pain (5-6 rating) while 27% reported severe pain (7-10 rating). Gender was not associated with pain intensity, but reduced functional performance, increasing number of symptoms, advanced HIV disease , physical symptom distress (MSAS-SF), and number of health comorbidities were significantly associated with pain intensity (P < .04). Increasing pain intensity was associated with greater functional ability impairment (BPI functional interference index) and poorer QOL. Pain is a common symptom among ambulatory HIV/AIDS patients and has a debilitating effect on QOL. There is a significant unmet need for pain relief in the population. PERSPECTIVE This article discusses the characteristics and effect of pain on function and QOL in East African patients. It also contributes information on characteristics of HIV/AIDS adult patients in the East Africa demonstrating the aspects in which pain is similar across different cultures.
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Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda.
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23
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Miaskowski C, Penko JM, Guzman D, Mattson JE, Bangsberg DR, Kushel MB. Occurrence and characteristics of chronic pain in a community-based cohort of indigent adults living with HIV infection. THE JOURNAL OF PAIN 2012; 12:1004-16. [PMID: 21684218 DOI: 10.1016/j.jpain.2011.04.002] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 03/18/2011] [Accepted: 04/01/2011] [Indexed: 11/18/2022]
Abstract
UNLABELLED Pain is common among people living with HIV/AIDS (PLWHA), but little is known about chronic pain in socioeconomically disadvantaged HIV-infected populations with high rates of substance abuse in the postantiretroviral era. This cross-sectional study describes the occurrence and characteristics of pain in a community-based cohort of 296 indigent PLWHA. Participants completed questionnaires about sociodemographics, substance use, depression, and pain. Cut-point analysis was used to generate categories of pain severity. Of the 270 participants who reported pain or the use of a pain medication in the past week, 8.2% had mild pain, 38.1% had moderate pain, and 53.7% had severe pain. Female sex and less education were associated with more severe pain. Depression was more common among participants with severe pain than among those with mild pain. Increasing pain severity was associated with daily pain and with chronic pain. Over half of the participants reported having a prescription for an opioid analgesic. Findings from this study suggest that chronic pain is a significant problem in this high risk, socioeconomically disadvantaged group of patients with HIV disease and high rates of previous or concurrent use of illicit drugs. PERSPECTIVE This article presents epidemiological data showing that unrelieved chronic pain is a significant problem for indigent people living with HIV. Participants reported pain severity similar to those with metastatic cancer. Despite high rates of substance use disorders, approximately half received prescriptions for opioid analgesics, although few for long-acting agents.
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Affiliation(s)
- Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, California, USA
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24
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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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Tsui JI, Cheng DM, Libman H, Bridden C, Samet J. Hepatitis C virus infection is associated with painful symptoms in HIV-infected adults. AIDS Care 2012; 24:820-7. [PMID: 22272656 DOI: 10.1080/09540121.2011.642989] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The study aim was to assess whether hepatitis C virus (HCV) was associated with painful symptoms among patients with HIV. Using data from a prospective cohort of HIV-infected adults with alcohol problems, we assessed the effects of HCV on pain that interfered with daily living and painful symptoms (muscle/joint pain, headache and peripheral neuropathy). Exploratory analyses assessed whether depressive symptoms and inflammatory cytokines mediated the relationship between HCV and pain. HCV-infected participants (n = 200) had higher odds of pain that interfered with daily living over time (adjusted odds ratio [AOR] 1.43; 95% CI: 1.02-2.01; p = 0.04) compared to those not infected with HCV. HIV/HCV co-infected participants had higher odds of muscle or joint pain (AOR 1.45; 95% CI: 1.06-1.97; p = 0.02) and headache (AOR 1.57; 95% CI: 1.18-2.07; p<0.01). The association between HCV and peripheral neuropathy did not reach statistical significance (AOR 1.33; 95% CI: 0.96-1.85; p = 0.09). Depressive symptoms and inflammatory cytokines did not appear to mediate the relationship between HCV and pain. Adults with HIV who are also co-infected with HCV are more likely to experience pain that interfered with daily living, muscle or joint pain, and headaches compared to those not co-infected. Research is needed to explore the association between HCV infection and pain, and to determine whether HCV treatment is an effective intervention.
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Affiliation(s)
- Judith I Tsui
- Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.
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Mphahlele NR, Mitchell D, Kamerman PR. Pain in ambulatory HIV-positive South Africans. Eur J Pain 2011; 16:447-58. [PMID: 22337525 DOI: 10.1002/j.1532-2149.2011.00031.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2011] [Indexed: 11/05/2022]
Abstract
We investigated the prevalence and intensity of pain, factors associated with having pain, and analgesic medications employed in a population consisting predominantly of Black African and female human immunodeficiency virus (HIV)-positive individuals attending outpatient clinics in a rural (n = 125; 79% female; 100% Black African) and a metropolitan (n = 396; 75% female; 94% Black African) area of South Africa. Pain intensity, interference and treatment were assessed using the Wisconsin Brief Pain Questionnaire. Seventy-two percent of rural participants and 56% of metropolitan participants had pain at the time of the interview, and this pain was moderate to severe in intensity in 60% of rural participants and 59% of metropolitan participants. Forty-six percent of rural participants and 61% of metropolitan participants had multiple pain sites. The most common pain sites in rural participants were the abdomen (30%), chest (26%), head (19%) and genitals (15%), while in the metropolitan cohort the head (39%), feet (33%), chest (30%) and abdomen (20%) were the most common sites. In the rural cohort, antiretroviral therapy was independently associated with reduced risk of pain, while in the metropolitan cohort increasing age was weakly, but independently associated with having pain. Pharmacological management of pain was poor, with 29% of rural participants and 55% of metropolitan participants with pain not receiving any treatment. Of those receiving treatment, no participants were receiving strong opioids, and only 3% of metropolitan participants were receiving a weak opioid. Thus, HIV-related pain is common and is poorly treated in both the rural and metropolitan setting in South Africa.
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Affiliation(s)
- N R Mphahlele
- 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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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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Tsao JCI, Stein JA, Ostrow D, Stall RD, Plankey MW. The mediating role of pain in substance use and depressive symptoms among Multicenter AIDS Cohort Study (MACS) participants. Pain 2011; 152:2757-2764. [PMID: 21962911 DOI: 10.1016/j.pain.2011.08.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 08/16/2011] [Accepted: 08/26/2011] [Indexed: 10/17/2022]
Abstract
Pain in human immunodeficiency virus (HIV) frequently co-occurs with substance use and depression. The complex associations among patient characteristics, pain, depression, and drug use in HIV suggests a role for testing models that can account for relationships simultaneously, control for HIV status, and also test for mediation. Using structural equation modeling, the current study examined associations among pain, sociodemographics, illicit drug use, and depressive symptoms in 921 HIV-seropositive and 1019 HIV-seronegative men from the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural history of HIV infection among gay/bisexual men. Longitudinal repeated measures data collected over a 6-year period were analyzed using predictive path models in which sociodemographics, HIV status, and CD4+ cell counts predicted pain, which, in turn, predicted depressive symptoms and illicit drug use. The path models did not differ substantially between HIV-seropositive and -seronegative men. Analyses using the total sample indicated that pain served both as a mediator and as a predictor of more use of cannabis, cocaine, and heroin, as well as more depressive symptoms. HIV-seropositive status predicted more use of inhaled nitrites. In this cohort, having lower CD4+ cell counts (predicted by HIV status), being African American, less educated, and older were all associated with more pain, which, in turn, was associated with more illicit drug use and more depressive symptoms. The results underscore the need for adequate pain management, particularly among vulnerable subgroups of HIV-seropositive and HIV-seronegative men to reduce the risk of drug use and depression.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, USA Department of Psychology, UCLA, Los Angeles, CA, USA The Chicago Multicenter AIDS Cohort Study (MACS) and the Ogburn-Stouffer Center for Social Organization Research at the National Opinion Research Center (NORC), University of Chicago, Chicago, IL, USA Graduate School of Public Health, Department of Behavioral and Community Health Services, University of Pittsburgh, Pittsburgh, PA, USA Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
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Chi X, Amet T, Byrd D, Chang KH, Shah K, Hu N, Grantham A, Hu S, Duan J, Tao F, Nicol G, Yu Q. Direct effects of HIV-1 Tat on excitability and survival of primary dorsal root ganglion neurons: possible contribution to HIV-1-associated pain. PLoS One 2011; 6:e24412. [PMID: 21912693 PMCID: PMC3166319 DOI: 10.1371/journal.pone.0024412] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 08/10/2011] [Indexed: 11/18/2022] Open
Abstract
The vast majority of people living with human immunodeficiency virus type 1 (HIV-1) have pain syndrome, which has a significant impact on their quality of life. The underlying causes of HIV-1-associated pain are not likely attributable to direct viral infection of the nervous system due to the lack of evidence of neuronal infection by HIV-1. However, HIV-1 proteins are possibly involved as they have been implicated in neuronal damage and death. The current study assesses the direct effects of HIV-1 Tat, one of potent neurotoxic viral proteins released from HIV-1-infected cells, on the excitability and survival of rat primary dorsal root ganglion (DRG) neurons. We demonstrated that HIV-1 Tat triggered rapid and sustained enhancement of the excitability of small-diameter rat primary DRG neurons, which was accompanied by marked reductions in the rheobase and resting membrane potential (RMP), and an increase in the resistance at threshold (R(Th)). Such Tat-induced DRG hyperexcitability may be a consequence of the inhibition of cyclin-dependent kinase 5 (Cdk5) activity. Tat rapidly inhibited Cdk5 kinase activity and mRNA production, and roscovitine, a well-known Cdk5 inhibitor, induced a very similar pattern of DRG hyperexcitability. Indeed, pre-application of Tat prevented roscovitine from having additional effects on the RMP and action potentials (APs) of DRGs. However, Tat-mediated actions on the rheobase and R(Th) were accelerated by roscovitine. These results suggest that Tat-mediated changes in DRG excitability are partly facilitated by Cdk5 inhibition. In addition, Cdk5 is most abundant in DRG neurons and participates in the regulation of pain signaling. We also demonstrated that HIV-1 Tat markedly induced apoptosis of primary DRG neurons after exposure for longer than 48 h. Together, this work indicates that HIV-1 proteins are capable of producing pain signaling through direct actions on excitability and survival of sensory neurons.
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Affiliation(s)
- Xianxun Chi
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Tohti Amet
- Center for AIDS Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Daniel Byrd
- Center for AIDS Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kuei-Hua Chang
- Department of Chemistry and Purdue University Center for Cancer Research, Purdue University, West Lafayette, Indiana, United States of America
| | - Kavita Shah
- Department of Chemistry and Purdue University Center for Cancer Research, Purdue University, West Lafayette, Indiana, United States of America
| | - Ningjie Hu
- Center for AIDS Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Ayslinn Grantham
- Center for AIDS Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Sishun Hu
- Center for AIDS Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Jianhong Duan
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Feng Tao
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Grant Nicol
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Qigui Yu
- Center for AIDS Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Tsui JI, Herman DS, Kettavong M, Anderson BJ, Stein MD. Chronic pain and hepatitis C virus infection in opioid dependent injection drug users. J Addict Dis 2011; 30:91-7. [PMID: 21491290 DOI: 10.1080/10550887.2011.554775] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
It is unknown whether infection with hepatitis C is a risk factor for pain among people who have used injection drugs. Multivariate regression was used to determine whether hepatitis C was associated with greater likelihood of reporting significant chronic pain and discomfort intolerance in a cohort of 97 injection drug users dependent on opioids. Study results suggest that participants with hepatitis C may be more likely to experience chronic pain (aOR=1.98; 95% confidence interval=0.76 to 5.12, p=0.16). Furthermore, hepatitis C was found to be associated with a higher discomfort intolerance scale score, reflecting intolerance to physical discomfort (β=2.34; 95% confidence interval=0.06 to 4.62; p=0.04). Hepatitis C may be a cause for chronic pain and discomfort intolerance that is overlooked among injection drug users dependent on opioids.
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Affiliation(s)
- Judith I Tsui
- Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA.
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Nair SN, Mary TR, Prarthana S, Harrison P. Prevalence of Pain in Patients with HIV/AIDS: A Cross-sectional Survey in a South Indian State. Indian J Palliat Care 2011; 15:67-70. [PMID: 20606859 PMCID: PMC2886211 DOI: 10.4103/0973-1075.53550] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Primary - To measure the prevalence of pain in HIV/AIDS with patients. Secondary - To assess the type, site, severity, management of pain and impact of pain on quality of life in these patients. DESIGN Multicentre cross-sectional survey (This paper is a pilot study). SETTINGS ART centre at St. John's Medical College Hospital, Bangalore and Snehadan, A supportive and care centre for HIV/ AIDS patients at Bangalore. MATERIALS AND METHODS Data sheet, Brief pain inventory and Short - Form McGill pain questionnaire. SUBJECTS This is an ongoing study and the pilot study includes 140 HIV/AIDS patients in different stages of the disease. RESULTS About 66.7% (28/42) in-patients and 24.5% (24/98) out-patients complained of pain. Of the 52 patients who reported pain, 32% (14/52) reported neuropathic pain and 68% (38/52) reported noci-ceptive pain. Headache was most common followed by pain in the soles of feet and low back. Only 26.9% (17/52) received any form of analgesic. Pain severity significantly affects the quality of life. CONCLUSIONS Pain is a common and debilitating symptom of HIV/AIDS. It is however, under-estimated and under treated.
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Affiliation(s)
- Shoba N Nair
- Department of Pain and Palliative Care, St. John's Medical College and Hospital, Bangalore - 560 034, India
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Opioid-Prescribing Practices and Provider Confidence Recognizing Opioid Analgesic Abuse in HIV Primary Care Settings. J Acquir Immune Defic Syndr 2011; 56 Suppl 1:S91-7. [DOI: 10.1097/qai.0b013e31820a9a82] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Tsao JCI, Stein JA, Dobalian A. Sex differences in pain and misuse of prescription analgesics among persons with HIV. PAIN MEDICINE 2010; 11:815-24. [PMID: 20456074 DOI: 10.1111/j.1526-4637.2010.00858.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Women represent the largest percentage of new HIV infections globally. Yet, no large-scale studies have examined the experience of pain and its treatment in women living with HIV. DESIGN This study used structural equation modeling to examine sex differences in pain and the use and misuse of prescription analgesics in a representative sample of HIV+ persons in the United Stated within a prospective, longitudinal design. OUTCOME MEASURES Bodily pain subscale of the Short-Form 36 and Modified Short Form of the World Health Organization's Composite International Diagnostic Interview (opioid misuse). RESULTS Women reported more pain than men over a roughly 6-month period regardless of mode of HIV transmission or prior drug use history. Men acknowledged more misuse of prescription analgesics over an approximate 1-year period compared with women, after taking into account pain, use of analgesics specifically for pain, and drug use history. Weaker associations between pain and use of analgesics specifically for pain that persisted over time were found among women compared with men. For both men and women, pain was stable over time. Problem drug use history exerted significant direct and indirect effects on pain, opioid misuse, and pain-specific analgesic use across sex. CONCLUSION The current findings are consistent with prior evidence indicating female pain predominance as well as the undertreatment of pain among women with HIV. Efforts should be made to improve the assessment and long-term management of pain in HIV+ persons.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024-1752, USA.
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Tsao JCI, Soto T. Pain in persons living with HIV and comorbid psychologic and substance use disorders. Clin J Pain 2009; 25:307-12. [PMID: 19590479 DOI: 10.1097/ajp.0b013e31819294b7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is a dearth of information on the experience of pain in persons living with human immunodeficiency virus (HIV) and cooccurring psychologic and substance use problems. This study examined the prevalence and correlates of pain in 162 HIV-positive persons diagnosed with mood and/or anxiety disorders and substance use disorders. METHODS Bodily pain scores in the current sample were compared with pain scores in the United States general population and HIV-positive persons who screened negative for psychologic and substance use problems. Bivariate analyses were used to identify significant correlates of pain scores in the current sample, which were then subjected to multiple regression analysis. RESULTS Pain scores in the current sample were significantly lower (indicating more pain) than the general population and HIV-positive persons who screened negative for psychologic and substance use problems. Multivariate analysis indicated that the presence of mood disorder, older age, and lower CD4 cell counts (below 200) were associated with increased pain. Presence of mood disorder accounted for the largest amount of unique variance in pain scores. DISCUSSION HIV-positive persons with diagnosed mood/anxiety and substance use disorders reported substantially higher levels of pain than the general population and HIV-positive persons without these comorbid conditions. The presence of mood disorder emerged as an important marker for pain in the current sample. Given that individuals living with HIV and comorbid psychologic and substance use disorders are at increased risk for pain, concerted efforts should be directed at identifying and treating pain in this population.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
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35
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Coughlan M. Pain and Palliative Care for People Living with HIV/AIDS in Asia. J Pain Palliat Care Pharmacother 2009. [DOI: 10.1080/j354v17n03_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Richardson JL, Heikes B, Karim R, Weber K, Anastos K, Young M. Experience of pain among women with advanced HIV disease. AIDS Patient Care STDS 2009; 23:503-11. [PMID: 19534600 DOI: 10.1089/apc.2008.0128] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We evaluated pain frequency and severity in 339 women enrolled in the Women's Interagency HIV Study (WIHS). Among these, 63% were 39 years of age or younger, 17% were white, 54% African American, and 29% Hispanic; 32% did not complete high school; 58% had a CD4 less than 200; 65% had clinical AIDS; 60% were on highly active antiretroviral therapy (HAART); and 32% had a viral load of 50,000 or more. Data were collected between 1996 and 1998. Within the past 6 months 190 (56%) women experienced pain 6 or more days and 168 (50%) women indicated pain severity scores of 4 or 5 (5-point scale). Pain frequency and pain severity were not associated with age, education, ethnicity, current therapy, or location of the WIHS site. Pain frequency and severity were related to lower CD4 count, higher depression, with a history and longer duration of smoking and use of marijuana. Severity was associated with a history of crack/cocaine or heroin use or with injection drug use as the transmission category. In the multivariate models, pain severity was related to CD4 count and depression and to current tobacco use but not to crack, cocaine, heroin, or marijuana use. Pain frequency was related to depression and to former tobacco, crack, cocaine, heroin, or marijuana use but not to current use. The long-term effects of tobacco use may be to increase pain experience but women may also smoke tobacco or use other substances to give mild pain relief. Pain is frequent and often severe among women with HIV requiring medical management.
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Affiliation(s)
- Jean L. Richardson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Bonnie Heikes
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Roksanna Karim
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kathleen Weber
- Department of Medicine, Cook County Hospital, Chicago, Illinois
| | - Kathryn Anastos
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Mary Young
- Department of Medicine, Georgetown University, Washington, D.C
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Weber J, Mitchell D, Kamerman PR. Oral administration of stavudine induces hyperalgesia without affecting activity in rats. Physiol Behav 2007; 92:807-13. [PMID: 17632188 DOI: 10.1016/j.physbeh.2007.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 05/02/2007] [Accepted: 06/06/2007] [Indexed: 01/31/2023]
Abstract
We have investigated whether long-term oral administration of the nucleoside reverse transcriptase inhibitor (NRTI) stavudine affects nociception in Sprague-Dawley rats, and whether any changes of nociception are accompanied by deterioration in activity and appetite. Stavudine (50 mg kg(-1)) was administered to rats orally once daily for six weeks in gelatine cubes. Mechanical hyperalgesia of the tail was assessed using a bar algometer, and thermal hyperalgesia by tail immersion in 49 degrees C water. Withdrawal latencies were compared to those of rats receiving placebo gelatine cubes. Withdrawal latencies to the noxious thermal challenge were not affected by stavudine, but those to the mechanical challenge were significantly decreased in rats receiving stavudine, compared to rats receiving placebo, from week three to week six of drug administration (P<0.05, ANCOVA with Newman Keuls post-hoc comparisons). The overall condition of the rats was assessed by recording daily voluntary wheel running distance and maximum running speed, food intake and body mass. Daily stavudine administration did not adversely affect voluntary running activity, appetite or growth. We have shown that long-term daily oral administration of the NRTI stavudine results in mechanical hyperalgesia in rats within three weeks without affecting appetite, growth and physical activity.
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Affiliation(s)
- Juliane Weber
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown, Gauteng, South Africa, 2193.
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Tsao JCI, Stein JA, Dobalian A. Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV. Pain 2007; 133:128-37. [PMID: 17449182 PMCID: PMC2173909 DOI: 10.1016/j.pain.2007.03.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 03/01/2007] [Accepted: 03/13/2007] [Indexed: 11/28/2022]
Abstract
Little is known about the relationship between pain and aberrant use of prescription analgesics in persons living with HIV. We examined the predictive and concurrent associations among pain, aberrant use of opioids, and problem drug use history in a nationally representative longitudinal sample of 2267 HIV+ persons. Covariance structure analyses tested a conceptual model wherein HIV+ patients with a history of problematic drug use (n=870), compared to those without such history (n=1397), were hypothesized to report more pain and aberrant opioid use, as well as use of opioids specifically for pain at baseline and 6- and 12-month follow-ups, after controlling for key sociodemographic characteristics. In support of the hypothesized model, patients with a history of problematic drug use reported more pain, and were more likely to report aberrant use of prescription analgesics, as well as use of such medications specifically for pain, compared to patients without such history. We also found a trend toward greater stability of aberrant opioid use over time in problem drug users compared with non-problem users suggesting a persistent pattern of inappropriate medication use in the former group. Our findings suggest that even though HIV+ persons with a history of problematic drug use report on-going patterns of using prescription analgesics specifically for pain, these patients continued to experience persistently higher levels of pain, relative to non-problem users. Among non-problem users, pain was not linked to aberrant use of opioids, but was linked to the use of such medications specifically for pain.
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Affiliation(s)
- Jennie C I Tsao
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Tsao JCI, Dobalian A, Stein JA. Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV. Pain 2005; 119:124-132. [PMID: 16297562 PMCID: PMC1362954 DOI: 10.1016/j.pain.2005.09.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Revised: 09/06/2005] [Accepted: 09/19/2005] [Indexed: 11/20/2022]
Abstract
We investigated predictive and concurrent relationships among reported pain, HIV/AIDS illness burden, and substance use history in 2,267 participants in the longitudinal HIV Cost and Services Utilization Study (HCSUS). Substance use history was classified as screening positive for current illicit drug use (N=253), past drug use (N=617), and non-user (N=1,397) at baseline. To control for demographic correlates, age, sex and socioeconomic status (SES) were included as predictors. Covariance structure models indicated greater pain at baseline among participants acknowledging current substance use. Pain at baseline was also directly predicted by greater HIV/AIDS illness burden, lower SES, and older age. At 6 months, pain was directly predicted by prior pain, worse concurrent HIV/AIDS illness burden and female sex. At 12 months, pain was predicted by older age, prior pain, and concurrent HIV/AIDS illness. It was also modestly but significantly predicted by current substance use at baseline. In addition to the direct effects on pain, there were significant indirect effects of demographic and drug use variables on pain mediated through HIV/AIDS illness burden and prior pain. There were significant and positive indirect effects of current and past drug use, greater age, and lower SES on pain at all three time periods. Pain at 6 months and pain at 12 months were also indirectly impacted by previous illness burden. Our results indicate that HIV+persons who screened positive for current use of a range of illicit substances experienced greater HIV/AIDS illness burden which in turn predicted increased pain.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10940 Wilshire Blvd., Suite 1450, Los Angeles, CA 90024, USA Department of Health Services, VA Greater Los Angeles Healthcare System HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, UCLA School of Public Health, Los Angeles, CA, USA UCLA Department of Psychology, Los Angeles, CA, USA
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Tsao JCI, Dobalian A, Myers CD, Zeltzer LK. Pain and use of complementary and alternative medicine in a national sample of persons living with HIV. J Pain Symptom Manage 2005; 30:418-32. [PMID: 16310616 PMCID: PMC1420635 DOI: 10.1016/j.jpainsymman.2005.05.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2005] [Indexed: 11/18/2022]
Abstract
The current study investigated the relationship of pain to use of complementary and alternative medicine (CAM) in a U.S. nationally representative sample of 2466 persons with human immunodeficiency virus (HIV), using data from the HIV Cost and Services Utilization Study. Pain was conceptualized as a need characteristic within the context of predisposing, enabling, and need (PEN) characteristics following Andersen's Behavioral Model of Health Services Use. Multivariate analyses were used to examine the association of baseline PEN characteristics with CAM use by follow-up (approximately 6 months later), including use of five specific CAM domains. Change in pain from baseline to follow-up was also examined in relation to CAM use. Baseline pain was a strong predictor of CAM use, and increased pain over time was associated with use of unlicensed or underground drugs with potential for harm. These results highlight the importance of medical efforts to control pain in persons living with HIV.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California 90024, USA
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Kohli RM, Sane S, Kumar K, Paranjape RS, Mehendale SM. Assessment of quality of life among HIV-infected persons in Pune, India. Qual Life Res 2005; 14:1641-7. [PMID: 16110943 DOI: 10.1007/s11136-004-7082-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study dimensions of Quality of Life (QOL) amongst HIV infected persons, their relationship with socio-demographic characteristics and disease progression. DESIGN Cross-sectional study with one time assessment of QOL. METHODS Modified Medical Outcome Study (MOS) core instrument [The Medical Outcome Study 116 core set of Measures of functioning and well being, Appendix A, core survey instrument (internet)] was interview--administered to 100 HIV infected individuals. RESULTS The instrument showed significant positive inter-domain correlations and desired linear association between QOL scores and the CD4 counts. The scale had a Cronbach alpha value of 0.75. QOL was markedly affected in the domains of physical health, work and earnings, routine activities and appetite and food intake. Women had significantly lower QOL scores than men despite having less advanced disease. The QOL scores were significantly lower among persons with lower CD4 counts mainly in different domains of physical health. CONCLUSIONS The modified MOS scale had the desired reliability and validity for evaluation of QOL in the HIV-infected persons in India. Low scores in the domains of physical health compared to other domains suggest a strategy to focus on medical intervention. A need for psychosocial intervention for women was perceived. Longitudinal studies must be done to assess the impact of anti-retroviral therapy being rolled out through the national programme on QOL.
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Affiliation(s)
- Rewa M Kohli
- National AIDS Research Institute, Indian Council of Medical Research, 73 G Block, MIDC Bhosari, Pune 411026, Maharashtra, India.
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Mosack KE, Abbott M, Singer M, Weeks MR, Lucy R. If I didn't have HIV, I'd be dead now: illness narratives of drug users living with HIV/AIDS. QUALITATIVE HEALTH RESEARCH 2005; 15:586-605. [PMID: 15802537 PMCID: PMC2910614 DOI: 10.1177/1049732304271749] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The purpose of this study is to illuminate the experiences of lower income, urban, HIV-positive drug users. The authors asked 60 participants about HIV risk behaviors, the impact of HIV on their lives, religious beliefs, life plans, relationships, and work-related issues both prior to and since diagnosis. They developed a theoretical framework based on illness narratives and ambiguous loss theories. Themes pertaining to both physical and emotional or spiritual dimensions were located within Benefit, Loss, or Status Quo orientations. The findings contribute to researchers' understanding of the HIV/AIDS illness experiences among the very marginalized and have important implications for physical and mental health care professionals working with HIV-positive drug users.
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Affiliation(s)
- Katie E. Mosack
- Center for AIDS Intervention Research (CAIR), 2071 N. Summit Avenue, Milwaukee, Wisconsin 53202; phone (414) 456-7740; fax (414) 287-4209
| | - Maryann Abbott
- Institute for Community Research, 2 Hartford Square West, Suite 100, Hartford, Connecticut 06106; phone (860) 278-2044; fax (860) 278-2141
| | - Merrill Singer
- Hispanic Health Council, 175 Main Street, Hartford, Connecticut 06106; phone (860) 527-0856; fax (860) 724-0437
| | - Margaret R. Weeks
- Institute for Community Research, 2 Hartford Square West, Suite 100, Hartford, Connecticut 06106; phone (860) 278-2044; fax (860) 278-2141
| | - Rohena Lucy
- Hispanic Health Council, 175 Main Street, Hartford, Connecticut 06106; phone (860) 527-0856; fax (860) 724-0437
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Tsao JCI, Dobalian A, Naliboff BD. Panic disorder and pain in a national sample of persons living with HIV. Pain 2004; 109:172-80. [PMID: 15082139 DOI: 10.1016/j.pain.2004.02.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Revised: 01/16/2004] [Accepted: 02/02/2004] [Indexed: 11/22/2022]
Abstract
Research to date has focused on depression and co-existing pain in HIV with relatively little attention devoted to the study of anxiety disorders and concurrent pain. We therefore examined the relationships among panic disorder, posttraumatic stress disorder (PTSD), major depression and pain in a US national sample of persons with HIV, controlling for key sociodemographic and clinical variables, including HIV disease status. The study sample comprised 1489 HIV+ individuals (representing 219 667 persons). In multivariate analyses, panic disorder showed a strong association with pain ( beta= -15.70; 99% confidence interval [CI]=-21.33 to -10.08; P<0.001, which was significantly greater than PTSD (P=0.002) but only marginally greater than major depression (P=0.002). Longitudinal analyses of the three psychological disorders revealed that increasing pain from baseline to follow-up (an approximately 6-month period) was associated with panic disorder only (relative risk ratio=2.18, 99% CI=1.02-4.69; P<0.01), after controlling for baseline pain scores, baseline HIV disease status and change in disease stage across time. We discuss specific mechanisms by which clinical anxiety and chronic pain may be mutually maintained in HIV+ individuals. Our findings suggest that panic disorder, as well as PTSD and major depression are associated with greater pain in HIV patients.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10940 Wilshire Blvd, Suite 1450, Los Angeles, CA 90024, USA.
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Abstract
BACKGROUND The negative impact of pain on health-related quality of life has been documented for persons with human immunodeficiency virus (HIV). Furthermore, pain could be an important factor in seeking medical care. However, the relationship between pain and health service utilization is poorly understood. OBJECTIVES The objective of this study was to investigate the effect of pain on use of outpatient services among a nationally representative sample of adults receiving medical care for HIV using Andersen's Behavioral Model of Health Services Use. METHODS We used Poisson regression to assess outpatient use over 6 months among 2267 respondents in the HIV Cost and Services Utilization Study. Key predisposing variables include gender and race/ethnicity. Enabling factors include income and insurance. Need factors include pain, CD4 count, and diagnosis of acquired immunodeficiency syndrome (AIDS). RESULTS Sixty-seven percent of respondents reported experiencing pain during the previous 4 weeks. Self-reported pain was higher among those with AIDS, intravenous drug-using females, the unemployed, and those without a baccalaureate degree, but lower among blacks. Patients reporting more pain and those developing more pain used more outpatient services. Poorer health (CD4 count <50 cells/mm3, less energy) was also associated with higher use. Persons with Medicare, Medicaid, or private insurance were more likely to have used outpatient services than the uninsured. Persons with a private HMO were no more likely to use services than those without insurance. CONCLUSIONS Improved pain management could reduce outpatient use for persons experiencing pain and lead to substantial cost savings. Inequalities in outpatient use related to insurance are evident.
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Affiliation(s)
- Aram Dobalian
- Department of Health Services Administration College of Health Professions, University of Florida, Gainesville, Florida 32610-0195, USA
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