Pain and Risk Behaviors Among HIV-Infected Persons in St. Petersburg, Russia

Tsui, Judith I.; Cheng, Debbie M.; Coleman, S. M.; Blokhina, Elena; Gnatienko, Natalia; Bryant, Kendall; Krupitsky, Evgeny; Zvartau, Edwin; Samet, Jeffrey H.

doi:10.1007/s10461-016-1593-5

Cited by 4 publications

(4 citation statements)

References 42 publications

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“…Associations with substance use have also been reported [8,38,39], with pain serving both as a mediator and as a predictor of more use of recreational drugs, as well as more depressive symptoms [46]. Other negative effects of pain include direct associations with reduced social support [26] and with higher rates of unprotected vaginal or anal sex [29], raising concern that pain in PLWH may also lead to worse outcomes on ART. Whilst we were unable to consider this association in our cross-sectional analysis (the majority of POPPY participants were on stable ART at recruitment), Surratt [7] reported that those with untreated pain had a 42% lower odds of 95% medication adherence in the previous week compared to those who were pain-free.…”

Section: Discussionmentioning

confidence: 99%

“…Among PLWH, pain is associated with poorer adherence to ART [20,21], higher rates of viral load rebound [22], treatment switching [23,24] and, in some subgroups, missed clinic visits [25]. Furthermore, PLWH in pain are more likely to experience lack of social support [26] and to be involved in risky behaviours such as alcohol use, intravenous drug use and sexual risk taking [6,[27][28][29][30]. Thus, in addition to the burdens placed on both the individual and the healthcare/social system, pain in PLWH has the potential to seriously curtail attempts to eliminate new HIV infections.…”

Section: Introductionmentioning

confidence: 99%

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Pain in people living with HIV and its association with healthcare resource use, well being and functional status

Sabin¹,

Harding

Bagkeris³

et al. 2018

Aids

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Objective: We describe the prevalence of pain and its associations with healthcare resource utilisation and quality-of-life. Design: The POPPY Study recruited three cohorts: older PLWH (≥50 years, n=699), younger demographically/lifestyle similar PLWH (<50 years, n=374) and older demographically/lifestyle similar HIV-negative (≥50 years, n=304) people from April 2013-February 2016. Methods: Current pain and pain-related healthcare use was collected via a self-reported questionnaire. Logistic regression assessed between-group differences in the prevalence of pain in the past month and current pain after controlling for potential confounders. Associations between current pain and healthcare resource use, reported joint problems, depressive symptoms, quality-of-life and functional status were assessed in PLWH using Mann-Whitney U and Chi-squared tests. Results: Pain in the past month was reported by 473/676 (70.0%) older PLWH, 224/357 (62.7%) younger PLWH and 188/295 (63.7%) older HIV-negative controls (p=0.03), with current pain reported in 330 (48.8%), 134 (37.5%) and 116 (39.3%), respectively (p=0.0007). Older PLWH were more likely to experience current pain, even after adjustment for confounders. Of those with pain in the past month, 56/412 (13.6%) had missed days of work or study due to pain, and 520 (59%) had seen a doctor about their pain. PLWH experiencing current pain had more depressive symptoms, poorer quality-of-life on all domains, and greater functional impairment, regardless of age group. Conclusions: Even in the effective ART era, pain remains common in PLWH and has a major impact on quality-of-life and associated healthcare and societal costs. Interventions are required to assist clinicians and PLWH to proactively manage pain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pain in people living with HIV and its association with healthcare resource use, well being and functional status

Sabin¹,

Harding

Bagkeris³

et al. 2018

Aids

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“…Thus, findings relating to ART exposure are likely to differ in this cohort to those from cohorts of newly diagnosed individuals starting cART. In Koeppe's study of PWH diagnosed with chronic pain, cART was associated with decreasing rates of pain over a median follow-up period of 5.2 years [13]. Among PWH attending a routine outpatient appointment in the UK in 2007 [14], the only HIV factors significantly associated with current pain in multivariable analyses were a longer time since HIV diagnosis and current receipt of a PI.…”

Section: Discussionmentioning

confidence: 96%

The predictors of pain extent in people living with HIV

Sabin¹,

Harding

Bagkeris³

et al. 2020

Aids

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Objective: To investigate the prevalence of widespread pain among people with HIV (PWH) and describe associations with antiretroviral therapy (ART) and markers of HIV disease stage.Design: Cross-sectional analysis of cohort study in the UK and Ireland. Methods: Pain information was collected during the baseline visit (conducted from 2013-2015) through a self-completed mannikin identifying pain at fifteen sites from five body regions. Pain was classified as widespread if reported at >4 regions and >7 sites, or regional otherwise. Chi-squared tests, Kruskal-Wallace tests and ordinal logistic regression were used to consider associations between pain extent and sociodemographic and HIV-related factors.

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“…Chronic pain is a common and significant problem for people with HIV (PWH). It affects up to 83% of PWH, and is associated with functional disability [1], frailty [2], high resource utilization [3,4], reduced quality of life [4], poor retention in care [5,6], suboptimal antiretroviral therapy (ART) adherence [5], and risk behaviors that can transmit HIV to others [[7], [8], [9], [10]]. Past enthusiasm for opioids as a treatment for chronic pain and under appreciation of their risks has created a large group of “legacy patients” who have been maintained on chronic opioids for pain, sometimes for years [11,12].…”

Section: Introductionmentioning

confidence: 99%

Decreasing risk among HIV patients on opioid therapy for chronic pain: Development of the TOWER intervention for HIV care providers

Robinson‐Papp

Aberg

Benn

et al. 2019

Contemporary Clinical Trials Communications

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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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Pain and Risk Behaviors Among HIV-Infected Persons in St. Petersburg, Russia

Cited by 4 publications

References 42 publications

Pain in people living with HIV and its association with healthcare resource use, well being and functional status

Pain in people living with HIV and its association with healthcare resource use, well being and functional status

The predictors of pain extent in people living with HIV

Decreasing risk among HIV patients on opioid therapy for chronic pain: Development of the TOWER intervention for HIV care providers

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