Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV

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 = 1397) 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.

Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

“…Previously, we found that patients with problematic drug use history experienced greater HIV/AIDS illness burden, which in turn predicted greater pain (Tsao et al 2005). Preliminary analyses for the current study revealed that whereas illness burden was related to pain-specific use of opioids in problem drug-users, illness burden was not related to aberrant analgesic use in either the problem or non-problem group.…”

“…Existing studies have not examined the use of opiates specifically for pain in HIV patients, taking into account previous substance abuse. In light of our prior findings that HIV patients with problem drug use history reported increased pain compared to non-problem users (Tsao et al 2005), it is reasonable to expect that problem drug users would be more likely to evidence increased use of opiates specifically for pain than the non-problem group.…”

“…Background variables-Detailed information on the demographic characteristics of the sample is available elsewhere Tsao et al 2005). To control for baseline demographic correlates in the present study, age, sex and socioeconomic status (SES) were included as predictors.…”

“…Pain Contact for correspondence: Jennie C. I. Tsao, PhD, Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10940 Wilshire Blvd., Suite 1450, Los Angeles, California 90024. management for these medically ill patients within the context of drug abuse presents a particular challenge. In a U.S national sample, we previously found that HIV+ persons with problem drug use history experienced greater HIV illness burden which in turn predicted increased pain (Tsao et al 2005). We did not however, examine the use of prescription pain medications in this prior investigation.…”

The mediating role of pain in substance use and depressive symptoms among Multicenter AIDS Cohort Study (MACS) participants

“…Pain in HIV seropositive persons is exacerbated when there is a coexisting psychological disorder [22,47,52,57], particularly depression [22,32,33]. Injection drug use (IDU) [15,23,37,60], as well as use of other illicit drugs (not just IDU) have also been associated with increased pain in HIV [58]. Efforts to identify which patients are more vulnerable to pain as well as depression and substance use, have indicated some common clinical and sociodemographic characteristics.…”