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Zhu X, Yi H, Gu J, Liu S, Hayashi K, Ikegami D, Pardo M, Toborek M, Roy S, Li H, Levitt RC, Hao S. Sirtuin 3 Mediated by Spinal cMyc-Enhancer of Zeste Homology 2 Pathway Plays an Important Role in Human Immunodeficiency Virus-Related Neuropathic Pain Model. Anesth Analg 2024; 139:647-659. [PMID: 38446700 DOI: 10.1213/ane.0000000000006873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Clinical data demonstrate that chronic use of opioid analgesics increases neuropathic pain in people living with human immunodeficiency virus (HIV). Therefore, it is important to elucidate the molecular mechanisms of HIV-related chronic pain. In this study, we investigated the role of the transcription factor cMyc, epigenetic writer enhancer of zeste homology 2 (EZH2), and sirtuin 3 (Sirt3) pathway in HIV glycoprotein gp120 with morphine (gp120M)-induced neuropathic pain in rats. METHODS Neuropathic pain was induced by intrathecal administration of recombinant gp120 with morphine. Mechanical withdrawal threshold was measured using von Frey filaments, and thermal latency using the hotplate test. Spinal expression of cMyc, EZH2, and Sirt3 were measured using Western blots. Antinociceptive effects of intrathecal administration of antisense oligodeoxynucleotide against cMyc, a selective inhibitor of EZH2, or recombinant Sirt3 were tested. RESULTS In the spinal dorsal horn, gp120M upregulated expression of cMyc (ratio of gp120M versus control, 1.68 ± 0.08 vs 1.00 ± 0.14, P = .0132) and EZH2 (ratio of gp120M versus control, 1.76 ± 0.05 vs 1.00 ± 0.16, P = .006), and downregulated Sirt3 (ratio of control versus gp120M, 1.00 ± 0.13 vs 0.43 ± 0.10, P = .0069) compared to control. Treatment with intrathecal antisense oligodeoxynucleotide against cMyc, GSK126 (EZH2 selective inhibitor), or recombinant Sirt3 reduced mechanical allodynia and thermal hyperalgesia in this gp120M pain model. Knockdown of cMyc reduced spinal EZH2 expression in gp120M treated rats. Chromatin immunoprecipitation (ChIP) assay showed that enrichment of cMyc binding to the ezh2 gene promoter region was increased in the gp120M-treated rat spinal dorsal horn, and that intrathecal administration of antisense ODN against cMyc (AS-cMyc) reversed the increased enrichment of cMyc. Enrichment of trimethylation of histone 3 on lysine residue 27 (H3K27me3; an epigenetic mark associated with the downregulation of gene expression) binding to the sirt3 gene promoter region was upregulated in the gp120M-treated rat spinal dorsal horn; that intrathecal GSK126 reversed the increased enrichment of H3K27me3 in the sirt3 gene promoter. Luciferase reporter assay demonstrated that cMyc mediated ezh2 gene transcription at the ezh2 gene promoter region, and that H3K27me3 silenced sirt3 gene transcription at the gene promoter region. CONCLUSION These results demonstrated that spinal Sirt3 decrease in gp120M-induced neuropathic pain was mediated by cMyc-EZH2/H3K27me3 activity in an epigenetic manner. This study provided new insight into the mechanisms of neuropathic pain in HIV patients with chronic opioids.
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Affiliation(s)
- Xun Zhu
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
- Department of Anesthesiology, the 6th Affiliated Hospital of Guangzhou Medical University and Qing Yuan People's Hospital, Qingyuan, Guangdong Province, China
| | - Hyun Yi
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Jun Gu
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Shue Liu
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Kentaro Hayashi
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Daigo Ikegami
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Marta Pardo
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Michal Toborek
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida
| | - Sabita Roy
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Heng Li
- Department of Anesthesiology, the 6th Affiliated Hospital of Guangzhou Medical University and Qing Yuan People's Hospital, Qingyuan, Guangdong Province, China
| | - Roy C Levitt
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- John T. MacDonald Foundation, Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida
| | - Shuanglin Hao
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida
- Miami VA Healthcare System, Miami, Florida
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2
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Tseng TY, Mitchell MM, Chander G, Latkin C, Kennedy C, Knowlton AR. Patient-centered Engagement as a Mediator in the Associations of Healthcare Discrimination, Pain Care Denial, and Later Substance Use Among a Sample of Predominately African Americans Living with HIV. AIDS Behav 2024; 28:429-438. [PMID: 38060111 DOI: 10.1007/s10461-023-04235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Chronic pain is prevalent and often under-addressed among people with HIV and people who use drugs, likely compounding the stress of discrimination in healthcare, and self-medicating along with its associated overdose risk or other problematic coping. Due to challenges in treating pain and HIV in the context of substance use, collaborative, patient-centered patient-provider engagement (PCE) may be particularly important for mitigating the impact of pain on illicit drug use and promoting sustained recovery. We examined whether PCE with primary care provider (PCE-PCP) mediated the effects of pain, discrimination, and denial of prescription pain medication on later substance use for pain among a sample of 331 predominately African Americans with HIV and a drug use history in Baltimore, Maryland, USA. Baseline pain level was directly associated with a higher chance of substance use for pain at 12 months (Standardized Coefficient = 0.26, p < .01). Indirect paths were observed from baseline healthcare discrimination (Standardized Coefficient = 0.05, 95% CI=[0.01, 0.13]) and pain medication denial (Standardized Coefficient = 0.06, 95% CI=[0.01, 0.14]) to a higher chance of substance use for pain at 12 months. Effects of prior discrimination and pain medication denial on later self-medication were mediated through worse PCE-PCP at 6 months. Results underscore the importance of PCE interpersonal skills and integrative care models in addressing mistreatment in healthcare and substance use in this population. An integrated approach for treating pain and substance use disorders concurrently with HIV and other comorbidities is much needed. Interventions should target individuals at multiple risks of discriminations and healthcare professionals to promote PCE.
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Affiliation(s)
- Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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3
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Marti L, Hünerwadel E, Hut B, Christ SM, Däster F, Schettle M, Seiler A, Blum D, Hertler C. Characteristics and clinical challenges in patients with substance use disorder in palliative care-experience from a tertiary center in a high-income country. BMC Palliat Care 2024; 23:28. [PMID: 38287302 PMCID: PMC10826251 DOI: 10.1186/s12904-024-01366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Access to palliative care is often limited for challenging and vulnerable groups, including persons with substance use disorders. However, with optimized healthcare options and liberal substitution policies, this patient group is likely to increase over the upcoming years, and comorbidities will also influence the need for palliative support. Here, we aim at analyzing characteristics and specific challenges associated with substance use disorders (SUD) in palliative care. METHODS We retrospectively reviewed all patients diagnosed with substance use disorder that were treated at our Competence Center Palliative Care within the University Hospital Zurich, Switzerland between 2015 and 2021. Patient characteristics, including age, gender, duration of hospitalization, as well as specific metrics like body mass index, distinct palliative care assessment scores, and in-hospital opioid consumption were retrieved from the electronic patient files. Demographics and clinical data were analyzed by descriptive statistics, and compared to those of a control group of palliative care patients without SUD. An opioid calculator was used to standardize opioid intake based on morphine equivalents for meaningful comparisons. RESULTS The primary characteristics revealed that the majority of individuals were single (56%), had no children (83%), lived alone (39%), and were either unemployed or recipients of a disability pension (in total 50%). Nicotine (89%), opioids (67%), and alcohol (67%) were the most used substances. We identified various comorbidities including psychiatric illnesses alongside SUD (56%), hepatitis A, B, or C (33%), and HIV infection (17%). Patients with SUD were significantly younger (p < 0.5), predominantly male (p < 0.05), and reported a higher prevalence of pain (p < 0.5) compared to the standard cohort of palliative patients. Regarding the challenges most frequently reported by healthcare practitioners, non-compliance, multimorbidity, challenging communication, biographical trauma, lack of social support, and unstable housing situations played a key role. CONCLUSION Patients with SUD represent a complex and vulnerable group dealing with multiple comorbidities that profoundly affect both their physical and psychological well-being. Understanding their unique characteristics is pivotal in providing precise and suitable palliative care.
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Affiliation(s)
| | | | - Bigna Hut
- University of Zurich, Zurich, Switzerland
| | - Sebastian M Christ
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Fabienne Däster
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Markus Schettle
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Annina Seiler
- University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - David Blum
- University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Caroline Hertler
- University of Zurich, Zurich, Switzerland.
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland.
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Yeh JC, Uebelacker LA, Pinkston MM, Anderson BJ, Busch AM, Abrantes AM, Baker JV, Stein MD. Anger and substance use in HIV-positive patients with chronic pain. AIDS Care 2023; 35:271-279. [PMID: 35727161 PMCID: PMC9768096 DOI: 10.1080/09540121.2022.2090490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
Chronic pain increases the risk of substance use in people living with HIV (PLWH). Depression and anxiety have also been identified as risk factors for substance use among PLWH. Relatedly, other negative mood states, such as anger, may influence chronic pain among PLWH. The current cross-sectional study examined whether the distinct negative mood state of anger is associated with substance use among 187 PLWH who report chronic pain. Using negative binomial regression analyses, we found higher levels of anger were positively associated with alcohol use. Higher levels of anger were inversely associated with benzodiazepine use. No association was found between anger and marijuana use, and there were no significant interactions between anger and pain severity on substance use. Our findings suggest that anger is an independent risk factor for substance use among PLWH and chronic pain. Addressing anger may be useful when adapting behavioral therapies in the treatment of pain among PLWH.
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Affiliation(s)
- Jih-Cheng Yeh
- Department of Health Law, Policy, and Management, Boston
University School of Public Health, Boston, MA, United States
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical
School of Brown University, Providence RI, USA
- Department of Family Medicine, Alpert Medical School of
Brown University, Providence, RI, USA
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906
USA
| | - Megan M. Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical
School of Brown University, Providence RI, USA
- Department of Medicine, Alpert Medical School of Brown
University, Providence, RI, USA
- Lifespan Physicians Group, The Miriam Hospital, Providence
RI, USA
| | | | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis
MN, USA
- Department of Medicine, University of Minnesota - Twin
Cities, Minneapolis MN, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical
School of Brown University, Providence RI, USA
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906
USA
| | - Jason V. Baker
- Department of Medicine, University of Minnesota - Twin
Cities, Minneapolis MN, USA
- Division of Infectious Diseases, Hennepin County Medical
Center, Minneapolis, MN
| | - Michael D. Stein
- Department of Health Law, Policy, and Management, Boston
University School of Public Health, Boston, MA, United States
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906
USA
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5
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Pinkston MM, Busch AM, Stein M, Baker J, Caviness C, Herman D, Weisberg R, Abrantes AM, Uebelacker LA. Improving functioning in HIV+ patients with chronic pain and comorbid depression: Protocol for a randomized clinical trial testing a collaborative behavioral health intervention based on behavioral activation. Contemp Clin Trials 2022; 119:106842. [PMID: 35777696 PMCID: PMC10739651 DOI: 10.1016/j.cct.2022.106842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Persons living with HIV (PWH) experience a disproportionate level of comorbid chronic pain and depression compared to individuals who do not have a diagnosis of HIV. Many PWH report pain that impairs daily function, is severe, and requires medical management. Depression alone is associated with HIV disease progression, medication non-adherence, and increased mortality. Given that numerous studies show that PWHs have chronic pain and depression despite pharmacologic treatment, there is a clear need for additional treatment modalities to address these conditions. DESIGN In this paper, we describe our protocol for a multisite, randomized controlled trial of the effectiveness of a collaborative behavioral intervention, called HIV-Pain and Sadness Support (HIVPASS), designed for PWH who endorse chronic pain and depressive symptoms, as compared to an attention matched Health Education (HE) condition. The HIVPASS intervention is based on Behavioral Activation and designed to target both pain and depression using an integrated model that promotes collaboration between HIV medical and psychological providers. SETTING AND METHODS We plan to (1) recruit PWH who endorse chronic pain and depression in three sites located in New England and the Midwestern United States and (2) compare our HIVPASS intervention to a full attention matched HE intervention with the primary outcome of pain interference, and secondary outcomes of depression, physical activity, HIV medication adherence, and health-related quality of life. Follow-up assessments will occur monthly for three months during the intervention phase and then during the post-intervention phase at months four, six, nine and twelve. CONCLUSIONS We provide descriptions of our protocol and interventions of our randomized controlled trial for comorbid chronic pain and depression in PWH. TRIAL REGISTRATION http://ClinicalTrials.govNCT02766751 https://clinicaltrials.gov/ct2/show/NCT02766751?term=stein%2C+michael&draw=2&rank=5.
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Affiliation(s)
- Megan M Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Lifespan Physicians Group, The Miriam Hospital, Providence, RI, USA.
| | - Andrew M Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Department of Medicine, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Michael Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Jason Baker
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Department of Medicine, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Celeste Caviness
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Debra Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Risa Weisberg
- VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research, Butler Hospital, Providence, RI, USA
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6
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Cedillo G, George MC, Deshpande R, Benn EKT, Navis A, Nmashie A, Siddiqui A, Mueller BR, Chikamoto Y, Weiss L, Scherer M, Kamler A, Aberg JA, Vickrey BG, Bryan A, Horn B, Starkweather A, Fisher J, Robinson-Papp J. Toward Safer Opioid Prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial. Addict Sci Clin Pract 2022; 17:28. [PMID: 35578356 PMCID: PMC9108346 DOI: 10.1186/s13722-022-00311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The 2016 U.S. Centers for Disease Control Opioid Prescribing Guideline (CDC Guideline) is currently being revised amid concern that it may be harmful to people with chronic pain on long-term opioid therapy (CP-LTOT). However, a methodology to faithfully implement the CDC guideline, measure prescriber adherence, and systematically test its effect on patient and public health outcomes is lacking. We developed and tested a CDC Guideline implementation strategy (termed TOWER), focusing on an outpatient HIV-focused primary care setting. METHODS TOWER was developed in a stakeholder-engaged, multi-step iterative process within an Information, Motivation and Behavioral Skills (IMB) framework of behavior change. TOWER consists of: 1) a patient-facing opioid management app (OM-App); 2) a progress note template (OM-Note) to guide the office visit; and 3) a primary care provider (PCP) training. TOWER was evaluated in a 9-month, randomized-controlled trial of HIV-PCPs (N = 11) and their patients with HIV and CP-LTOT (N = 40). The primary outcome was CDC Guideline adherence based on electronic health record (EHR) documentation and measured by the validated Safer Opioid Prescribing Evaluation Tool (SOPET). Qualitative data including one-on-one PCP interviews were collected. We also piloted patient-reported outcome measures (PROMs) reflective of domains identified as important by stakeholders (pain intensity and function; mood; substance use; medication use and adherence; relationship with provider; stigma and discrimination). RESULTS PCPs randomized to TOWER were 48% more CDC Guideline adherent (p < 0.0001) with significant improvements in use of: non-pharmacologic treatments, functional treatment goals, opioid agreements, prescription drug monitoring programs (PDMPs), opioid benefit/harm assessment, and naloxone prescribing. Qualitative data demonstrated high levels of confidence in conducting these care processes among intervention providers, and that OM-Note supported these efforts while experience with OM-App was mixed. There were no intervention-associated safety concerns (defined as worsening of any of the PROMs). CONCLUSIONS CDC-guideline adherence can be promoted and measured, and is not associated with worsening of outcomes for people with HIV receiving LTOT for CP. Future work would be needed to document scalability of these results and to determine whether CDC-guideline adherence results in a positive effect on public health. Trial registration https://clinicaltrials.gov/ct2/show/NCT03669939 . Registration date: 9/13/2018.
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Affiliation(s)
- Gabriela Cedillo
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Mary Catherine George
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Richa Deshpande
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA
- Caring Accent (Consultancy), San Jose, CA, USA
- Department of Economics and the Center On Alcoholism, Substance Use and Addictions, University of New Mexico, Albuquerque, USA
- Center for Evaluation and Applied Research, New York Academy of Medicine, New York, USA
- School of Nursing, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration On Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Emma K T Benn
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Alexandra Nmashie
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Alina Siddiqui
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Bridget R Mueller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | | | - Linda Weiss
- Center for Evaluation and Applied Research, New York Academy of Medicine, New York, USA
| | - Maya Scherer
- Center for Evaluation and Applied Research, New York Academy of Medicine, New York, USA
| | - Alexandra Kamler
- Center for Evaluation and Applied Research, New York Academy of Medicine, New York, USA
| | - Judith A Aberg
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Angela Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA
| | - Brady Horn
- Department of Economics and the Center On Alcoholism, Substance Use and Addictions, University of New Mexico, Albuquerque, USA
| | | | - Jeffrey Fisher
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Institute for Collaboration On Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA.
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7
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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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8
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Abstract
The evolution of therapeutics for and management of human immunodeficiency virus-1 (HIV-1) infection has shifted it from predominately manifesting as a severe, acute disease with high mortality to a chronic, controlled infection with a near typical life expectancy. However, despite extensive use of highly active antiretroviral therapy, the prevalence of chronic widespread pain in people with HIV remains high even in those with a low viral load and high CD4 count. Chronic widespread pain is a common comorbidity of HIV infection and is associated with decreased quality of life and a high rate of disability. Chronic pain in people with HIV is multifactorial and influenced by HIV-induced peripheral neuropathy, drug-induced peripheral neuropathy, and chronic inflammation. The specific mechanisms underlying these three broad categories that contribute to chronic widespread pain are not well understood, hindering the development and application of pharmacological and nonpharmacological approaches to mitigate chronic widespread pain. The consequent insufficiencies in clinical approaches to alleviation of chronic pain in people with HIV contribute to an overreliance on opioids and alarming rise in active addiction and overdose. This article reviews the current understanding of the pathogenesis of chronic widespread pain in people with HIV and identifies potential biomarkers and therapeutic targets to mitigate it.
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Affiliation(s)
- Dylan R Addis
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer J DeBerry
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Saurabh Aggarwal
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Pulmonary Injury and Repair Center, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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9
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Robinson-Papp J, Aberg J, Benn EK, Bryan A, Cedillo G, Chikamoto Y, George MC, Horn B, Kamler A, Navis A, Nmashie A, Scherer M, Starkweather A, Vickrey B, Weiss L, Yang Q, Fisher J. Decreasing risk among HIV patients on opioid therapy for chronic pain: Development of the TOWER intervention for HIV care providers. Contemp Clin Trials Commun 2019; 16:100468. [PMID: 31701042 PMCID: PMC6831717 DOI: 10.1016/j.conctc.2019.100468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/24/2019] [Accepted: 10/10/2019] [Indexed: 12/18/2022] Open
Abstract
Many people with HIV (PWH) experience chronic pain that limits daily function and quality of life. PWH with chronic pain have commonly been prescribed opioids, sometimes for many years, and it is unclear if and how the management of these legacy patients should change in light of the current US opioid epidemic. Guidelines, such as the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain (CDCG), provide recommendations for the management of such patients but have yet to be translated into easily implementable interventions; there is also a lack of strong evidence that adhering to these recommendations improves patient outcomes such as amount of opioid use and pain levels. Herein we describe the development and preliminary testing of a theory-based intervention, called TOWER (TOWard SafER Opioid Prescribing), designed to support HIV primary care providers in CDCG-adherent opioid prescribing practices with PWH who are already prescribed opioids for chronic pain. TOWER incorporates the content of the CDCG into the theoretical and operational framework of the Information Motivation and Behavioral Skills (IMB) model of health-related behavior. The development process included elicitation research and incorporation of feedback from providers and PWH; testing is being conducted via an adaptive feasibility clinical trial. The results of this process will form the basis of a large, well-powered clinical trial to test the effectiveness of TOWER in promoting CDCG-adherent opioid prescribing practices and improving outcomes for PWH with chronic pain.
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Affiliation(s)
| | - Judith Aberg
- Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Infectious Diseases, USA
| | - Emma K.T. Benn
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, USA
| | - Angela Bryan
- University of Colorado Boulder, Department of Psychology and Neuroscience, USA
| | - Gabriela Cedillo
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | | | | | - Brady Horn
- University of New Mexico Center on Alcoholism, Substance Abuse and Addictions, USA
| | - Alexandra Kamler
- New York Academy of Medicine, Center for Evaluation and Applied Research, USA
| | - Allison Navis
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | - Alexandra Nmashie
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | - Maya Scherer
- New York Academy of Medicine, Center for Evaluation and Applied Research, USA
| | | | - Barbara Vickrey
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | - Linda Weiss
- New York Academy of Medicine, Center for Evaluation and Applied Research, USA
| | - Qiuchen Yang
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, USA
| | - Jeffrey Fisher
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, USA
- University of Connecticut, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), USA
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10
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Witham G, Yarwood G, Wright S, Galvani S. An ethical exploration of the narratives surrounding substance use and pain management at the end of life: a discussion paper. Nurs Ethics 2019; 27:1344-1354. [PMID: 31526085 PMCID: PMC7406987 DOI: 10.1177/0969733019871685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This discussion article examines narrative positioning related to pain management for people who use substances at the end of life. We explore how dominant narrative genres associated with biomedicine, such as ‘restitution’ and narratives common within the context of drug services such as ‘recovery’ can hinder effective pain management within this population. We argue that these discourses can marginalise the ethical self-identity of patients who use substances at the end of life. It can also trouble health and social care professionals in supporting patients and generating counter-narratives that challenge those often associated with substance use. Stigma is a common experience for this population with stereotyping as ‘junkies’ and associated with criminality. They are positioned as drug-seeking, and this requires more surveillance at the end of life when opioid therapy is potentially more available and authorised. This can make it challenging to generate ‘companion’ stories that are positive and maintain moral adequacy. Dominant biomedical narrative genres often prevent the recognition of the fractured stories that people using substances can often present with. This can lead to narrative silencing and to the under treatment of pain. The person’s self-identity is invested in narratives of recovery, and opioid use symbolises their addicted past because for practitioners, this population is at clinical risk with the potential for drug seeking behaviours. Whilst not requiring formal ethical review this discussion paper was constructed in accordance with good scientific practice with the work of other researchers respected and cited appropriately.
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11
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Scott W, Arkuter C, Kioskli K, Kemp H, McCracken LM, Rice AS, de C. Williams AC. Psychosocial factors associated with persistent pain in people with HIV: a systematic review with meta-analysis. Pain 2018; 159:2461-2476. [PMID: 30130299 PMCID: PMC6250281 DOI: 10.1097/j.pain.0000000000001369] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/26/2018] [Indexed: 01/11/2023]
Abstract
Chronic pain remains a prevalent and disabling problem for people living with HIV in the current antiretroviral treatment era. Psychosocial treatments may have promise for managing the impact of this pain. However, research is needed to identify psychosocial processes to target through such treatments. The current systematic review and meta-analysis examined the evidence for psychosocial factors associated with pain, disability, and quality of life in people living with HIV and persistent pain. Observational and experimental studies reporting on the association between one or more psychosocial factors and one or more pain-related variables in an adult sample of people living with HIV and pain were eligible. Two reviewers independently conducted eligibility screening, data extraction, and quality assessment. Forty-six studies were included in the review and 37 of these provided data for meta-analyses (12,493 participants). "Some" or "moderate" evidence supported an association between pain outcomes in people with HIV and the following psychosocial factors: depression, psychological distress, posttraumatic stress, drug abuse, sleep disturbance, reduced antiretroviral adherence, health care use, missed HIV clinic visits, unemployment, and protective psychological factors. Surprisingly, few studies examined protective psychological factors or social processes, such as stigma. There were few high-quality studies. These findings can inform future research and psychosocial treatment development in this area. Greater theoretical and empirical focus is needed to examine the role of protective factors and social processes on pain outcomes in this context. The review protocol was registered with PROSPERO (CRD42016036329).
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Affiliation(s)
- Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Chinar Arkuter
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Kitty Kioskli
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Harriet Kemp
- Pain Research Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lance M. McCracken
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew S.C. Rice
- Pain Research Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Amanda C. de C. Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
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12
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A Biopsychosocial Approach to Managing HIV-Related Pain and Associated Substance Abuse in Older Adults: a Review. AGEING INTERNATIONAL 2018. [DOI: 10.1007/s12126-018-9333-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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13
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Ebenau A, Dijkstra B, Stal-Klapwijk M, ter Huurne C, Blom A, Vissers K, Groot M. Palliative care for patients with a substance use disorder and multiple problems: a study protocol. BMC Palliat Care 2018; 17:97. [PMID: 30075776 PMCID: PMC6091086 DOI: 10.1186/s12904-018-0351-z] [Citation(s) in RCA: 7] [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] [Received: 08/31/2017] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The specific palliative care needs and problems of patients with a substance use disorder and multiple problems, and those of their proxies, are under recognized Besides, the organization of palliative care, including the division of health care professionals' responsibilities, is often unclear. Perspectives of patients and proxies are hardly known. We describe the outline of a study designed to explore how palliative care for patients with a substance use disorder is organized in the Netherlands and to explore problems and needs, as well as possible improvements from the healthcare professionals', patients' and proxies' perspective. The aim of this protocol paper is to provide insights in ways to conduct research with vulnerable research participants and to offer a detailed description of the study design. The broader study aims to gain insight in and formulate recommendations on how to improve palliative care for patients with a substance use disorder. METHODS A qualitative study with patients, proxies and healthcare professionals. Semi-structured interviews will be held with 10-15 patients who suffer from a severe substance use disorder. They are in a palliative care trajectory and either diagnosed with a chronic or life-threatening disease or, as a result of addictive behavior, a physical deterioration without the prospect of cure. Semi-structured interviews will also be held with 5-10 proxies. Healthcare professionals, volunteers and/or 'experts-by-experience' (n = 24-40) will be participating in semi-structured group interviews. All (group) interviews will be thematically analyzed. Additionally, a strengths, weaknesses, opportunities and threats (SWOT) analysis will be applied to the group interview data with the aim to summarize and concretize the findings. DISCUSSION Everyone has a right to an optimal end-of-life phase of life and a dignified dying process. This study will provide valuable knowledge about palliative care for patients with a substance use disorder and explicitly bring to light the needs and problems of the patients and their proxies and healthcare professionals in a palliative care phase.
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Affiliation(s)
- Anne Ebenau
- Salvation Army, Central Netherlands, Zandvoortweg 211; 3741 BE, Baarn, the Netherlands
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), P.O. Box 6909, 6503 GK Nijmegen, the Netherlands
| | | | - Chantal ter Huurne
- Tactus Addiction care, Lokatie Ripperdastraat, Ripperdastraat 8, 7511 JR Enschede, The Netherlands
| | - Ans Blom
- Network Palliative Care region Arnhem and de Liemers, Hospice Rozenheuvel, Rosendaalselaan 20, 6891 DD Rozendaal, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Expertise Center for Palliative Care, Internal Post 549, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Marieke Groot
- Salvation Army, Central Netherlands, Zandvoortweg 211; 3741 BE, Baarn, the Netherlands
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Expertise Center for Palliative Care, Internal Post 549, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
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14
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Anagnostopoulos A, Abraham AG, Genberg BL, Kirk GD, Mehta SH. Prescription drug use and misuse in a cohort of people who inject drugs (PWID) in Baltimore. Addict Behav 2018; 81:39-45. [PMID: 29425791 PMCID: PMC5845821 DOI: 10.1016/j.addbeh.2018.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prescription drug misuse and its consequences (e.g., overdose) are a major public health concern. While national focus has been on opioids, misuse of sedatives/tranquilizers also occurs. Here we describe the use, correlates, and sources of prescription drugs in a community-based cohort of people who inject drugs (PWID). METHODS We included participants of the AIDS Linked to the IntraVenous Experience (ALIVE) study in follow-up in 2014. We defined prescription drug use as use of opioids or sedatives/tranquilizers considering both medical "prescribed by a doctor" and non-medical sources "obtained from the street/friend/relative." Correlates were evaluated separately for opioids and sedatives/tranquilizers using logistic regression and included socioeconomic factors, health conditions, substance use, and health care access. RESULTS 823 predominantly African-American (90.6%) and male (66.3%) ALIVE participants with a median age of 55 were included. Prevalence of prescription opioid and sedative/tranquilizer use was 25.3% and 16.3% respectively. While the majority (70%) obtained prescription drugs exclusively through medical sources, the 30% who reported any non-medical source were also more likely to use other substances by injection and non-injection routes. PWID reporting prescription drug use (from medical and non-medical sources) were significantly more likely to report other substance use, mental health disorder, and recent contact with health care providers or detoxification facilities. CONCLUSIONS Prescription drug use was highly prevalent among PWID. While it is difficult to distinguish medically indicated from non-medical use, high levels of prescription drug use in conjunction with other drugs and alcohol heightens the risk for drug overdose and other adverse consequences.
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Affiliation(s)
- Alexia Anagnostopoulos
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA.
| | - Alison G Abraham
- Department of Ophthalmology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore 21287, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA.
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA.
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore 21287, MD, USA.
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA.
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15
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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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16
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Mitchell MM, Nguyen TQ, Isenberg SR, Maragh-Bass AC, Keruly J, Knowlton AR. Psychosocial and Service Use Correlates of Health-Related Quality of Life Among a Vulnerable Population Living with HIV/AIDS. AIDS Behav 2017; 21:1580-1587. [PMID: 27787675 DOI: 10.1007/s10461-016-1589-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Among people living with HIV/AIDS (PLHIV), health-related quality of life (HRQOL) is an important clinical metric of perceived well-being. Baseline data from the BEACON study (N = 383) were used to examine relationships between HRQOL and negative social support, HIV-related stigma, viral suppression, and physical and mental health service use among a vulnerable population of low-income, urban PLHIV who currently or formerly used substances, and were primarily African American. Factor analyses and structural equation modeling indicated that increases in negative social support, stigma, mental health care visits and HIV physician visits were associated with lower HRQOL, while viral suppression was associated with greater HRQOL. The association between negative social support and HRQOL suggests the importance of intervening at the dyad or network levels to shape the type of social support being provided to PLHIV. HIV-related stigma is another negative social factor that is prevalent in this sample and could be addressed by intervention. Results indicate that greater mental and physical health service use can be used to identify individuals with lower HRQOL. Therefore, findings increase an understanding of HRQOL in this understudied population and have implications for designing interventions to improve HRQOL among PLHIV.
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17
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Harrell PT, Fu H. Commentary on Betts et al. (2016): Polysubstance use and opioid substitution therapy among people who inject drugs. Addiction 2016; 111:1224-5. [PMID: 27273387 DOI: 10.1111/add.13417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Paul T Harrell
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA. .,Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Hongyun Fu
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
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18
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Mitchell MM, Maragh-Bass AC, Nguyen TQ, Isenberg S, Knowlton AR. The role of chronic pain and current substance use in predicting negative social support among disadvantaged persons living with HIV/AIDS. AIDS Care 2016; 28:1280-6. [PMID: 27050708 DOI: 10.1080/09540121.2016.1168916] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Chronic pain and substance use can strain the supportive relationships of persons with serious chronic illness, which may increase the likelihood of receiving negative, rather than positive, social support from informal caregivers and social network members. To our knowledge, this is the first study to longitudinally examine the effects of chronic pain and substance use on negative social support. The sample (N = 383) comprised disadvantaged, primarily African-American, persons living with HIV/AIDS with a history of injection drug use, 32.4% of whom reported frequent or constant pain in the prior 6 months. Using factor analysis and structural equation modeling, current substance use and greater levels of chronic pain positively predicted negative social support 12 months later, after controlling for baseline negative support, viral load, age and sex. We also found a significant interaction effect such that among those not using substances, there was a significant positive association between pain and negative support, but no such association among those currently using substances. The findings emphasize the importance of treatment of chronic pain and substance use in the supportive functioning of social networks of a disadvantaged population with serious chronic conditions and persistent health disparities.
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Affiliation(s)
- Mary M Mitchell
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Allysha C Maragh-Bass
- b Department of Surgery, Harvard School of Medicine, Harvard School of Public Health, Center for Surgery and Public Health , Brigham and Women's Hospital , Boston , MA , USA
| | - Trang Q Nguyen
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sarina Isenberg
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Amy R Knowlton
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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