Occurrence and Characteristics of Chronic Pain in a Community-Based Cohort of Indigent Adults Living With HIV Infection

Abstract

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 post-antiretroviral 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.

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

“…11 Prescribing opioid analgesics to HIV-infected patients, who have both a higher underlying prevalence of substance use disorders and pain conditions, is complicated. [12][13][14][15] The benefits of opioids for treating painful conditions, such as neuropathy and osteonecrosis, which may occur more commonly among HIV-infected patients, must be balanced against 16,17 the possibility of increased risk for harm. Opioids may impact immune function, 18 be associated with toxicities [19][20][21] and interact with antiretrovirals.…”

“…22 There are limited recent data examining factors associated with opioid prescribing to HIV-infected patients. Existing studies focus on long-term therapy; 12,14 lack an uninfected comparison group; 7,14,15 and do not consider opioid indication. 12,14 Furthermore, some of these studies were conducted within a single site, 7,15 which may limit their generalizability.…”

“…Existing studies focus on long-term therapy; 12,14 lack an uninfected comparison group; 7,14,15 and do not consider opioid indication. 12,14 Furthermore, some of these studies were conducted within a single site, 7,15 which may limit their generalizability. 23 Therefore, we conducted a crosssectional study to: 1) describe opioid analgesic receipt in a large sample of HIV-infected and uninfected patients; 2) determine whether opioid receipt varies by HIV status; and 3) identify factors associated with receipt of any opioid analgesics, high-dose opioids and long-term opioids.…”

Chronic pain related to AIDS: perspective of nurses and doctors

“…Os discursos evidenciaram que, apesar do número crescente de pacientes com AIDS e sintomas de dor crônica, o sub-reconhecimento e o subtratamento desta permanecem um desafio, configurando-se num problema significante que contribui a morbidade psicológica e funcional dos portadores, principalmente daqueles socioeconomicamente desfavorecidos, com HIV e altas taxas de uso prévio ou concomitante de drogas ilícitas (10) . Tal achado pode ser justificado pelo fato da entrada do sujeito soropositivo ao HIV no cenário de cuidado ter ocorrido, muitas das vezes, sem a devida preparação e capacitação do profissional, especialmente na década de 80 e início de 90.…”

Qualitative Investigation of a Brief Chronic Pain Screening Tool in HIV-Infected Patients

“…17 Most studies of chronic pain prevalence in HIV-infected patients rely on queries pertaining to short time frames (1 day to 1 month), [5][6][7][8][9][10][11][12][13] or methods of screening for chronic pain that have not been validated in any clinical population. 13 Furthermore, well-validated pain questionnaires, such as the Brief Pain Inventory 18 and Multidimensional Pain Inventory, 19 have been used to study pain in patients with HIV, [5][6][7][8][9][10][11][12][13] but are not designed as screeners. As detailed questionnaires, they were designed to understand pain's impact on physical and emotional function in patients already known to have a pain condition, whether acute or chronic.…”