Chronic Pain in HIV-Infected Patients: Relationship to Depression, Substance Use, and Mental Health and Pain Treatment

Abstract

Objective Since the advent of highly active antiretroviral therapy (HAART), HIV has become a chronic disease for most individuals in developed countries. Chronic pain is a common occurrence for HIV –infected patients and has an impact on quality of life and antiretroviral adherence. The objective of this study was to examine relationships between chronic pain and depression, substance use, mental health treatment, and pain treatment in HIV-infected patients. Design Cross-sectional study. Setting Three primary care sites where HIV+ patients receive treatment. Subjects 238 HIV-infected primary care patients. Methods We collected self-report and chart-review information on demographics, HIV clinical status, chronic pain, depression, substance use, mental health treatment, and pain treatment. We collected data between October 2012 and November 2013. Results Of the patients enrolled in this study, 107 reported no chronic pain, 24 reported mild chronic pain, and 107 reported moderate-severe chronic pain. Participants in the moderate-severe pain group were more likely to have high levels of depressive symptoms than those in the no chronic pain group. Similarly, there was a significant relationship between chronic pain status and interference with life activities due to pain. Participants with moderate-severe chronic pain were more likely to be taking an antidepressant medication than those with mild chronic pain, and more likely to be taking a prescription opioid than the other two groups. We did not find a significant relationship between problematic substance use and chronic pain status. Conclusions Despite pharmacologic treatment, moderate-severe chronic pain and elevated depression symptoms are common among HIV-infected patients and frequently co-occur.

Brief Report: Longitudinal Opioid Use Among HIV-Infected Patients, 2000 to 2014

“…following an illness, injury or surgery). Although estimates of chronic pain prevalence in HIV-infected populations range from 53–90%, 15,16 only 16% received chronic opioid treatment in this cohort. We were unable to assess receipt of alternate pain management.…”

Pilot Randomized Trial of Collaborative Behavioral Treatment for Chronic Pain and Depression in Persons Living with HIV/AIDS

“…Even in the era of Highly Active Antiretroviral Treatment (HAART), 34–48% of persons living with HIV/AIDS (PLWH) report having experienced pain in the prior week, with reports of chronic pain in various parts of the body (1). In PLWH with pain, rates of depression are particularly high (1).…”

“…In PLWH with pain, rates of depression are particularly high (1). As shown in non-HIV populations, chronic pain patients with comorbid depression have a poorer response to pain treatment (2).…”

“…Existing pharmacological treatments for pain in PLWH do not seem to adequately mitigate suffering in all PLWH (1). Further complicating pharmacologic pain management, many PLWH have a history of substance abuse and misuse of prescribed opioid analgesics.…”

The role of chronic pain and current substance use in predicting negative social support among disadvantaged persons living with HIV/AIDS

“…An estimated 30% to 60% of PLHIV in medical care in the United States have chronic pain, which, among PLHIV, is associated with chronic conditions such as substance use disorders, to which they are at high risk, as well as neuropathies caused by HIV and by certain classes of medications used to treat HIV (Dorfman et al, 2013; Ellis et al, 2010; Miaskowski et al, 2011; Phillips, Cherry, Cox, Marshall, & Rice, 2010). Indeed, peripheral neuropathy alone affects a significant proportion of PLHIV and all persons by late stage HIV; and tends to be chronic, resistant to common treatments, and is the major cause of disability among PLHIV (Hanass-Hancock, Regondi, van Egeraat, & Nixon, 2013; Phillips et al, 2010; Simpson et al, 2010; Uebelacker et al, 2015; Wulff, Wang, & Simpson, 2000). No commonly available analgesics have shown efficacy over placebo in reducing neuropathic pain in PLHIV (Phillips et al, 2010; Simpson et al, 2010).…”