Pain in ambulatory HIV‐positive South Africans

Abstract

We investigated the prevalence and intensity of pain, factors associated with having pain, and analgesic medications employed in a population consisting predominantly of Black African and female human immunodeficiency virus (HIV)-positive individuals attending outpatient clinics in a rural (n = 125; 79% female; 100% Black African) and a metropolitan (n = 396; 75% female; 94% Black African) area of South Africa. Pain intensity, interference and treatment were assessed using the Wisconsin Brief Pain Questionnaire. Seventy-two percent of rural participants and 56% of metropolitan participants had pain at the time of the interview, and this pain was moderate to severe in intensity in 60% of rural participants and 59% of metropolitan participants. Forty-six percent of rural participants and 61% of metropolitan participants had multiple pain sites. The most common pain sites in rural participants were the abdomen (30%), chest (26%), head (19%) and genitals (15%), while in the metropolitan cohort the head (39%), feet (33%), chest (30%) and abdomen (20%) were the most common sites. In the rural cohort, antiretroviral therapy was independently associated with reduced risk of pain, while in the metropolitan cohort increasing age was weakly, but independently associated with having pain. Pharmacological management of pain was poor, with 29% of rural participants and 55% of metropolitan participants with pain not receiving any treatment. Of those receiving treatment, no participants were receiving strong opioids, and only 3% of metropolitan participants were receiving a weak opioid. Thus, HIV-related pain is common and is poorly treated in both the rural and metropolitan setting in South Africa.

Prevalence and Correlates of Pain and Pain Treatment in a Western Kenya Referral Hospital

“…18,19 Unlike Harding and colleagues, we did not find that female gender was correlated with symptom burden. 20 This difference may rest in the fact that we investigated correlates of pain only, while Harding and colleagues investigated correlates of physical burden as a whole, including but not limited to pain.…”

“…[14][15][16][17] Research on the correlates of pain in SSA has found that in HIV patients, pain has been associated with increasing age, female gender, not being on antiretroviral therapy, number of symptoms, advanced disease, number of medical comorbidities, and reduced functional performance scores. [18][19][20] These studies are specific to ambulatory HIV/AIDS patients, and to date no research has been conducted to determine the burden of pain in a mixed inpatient hospital setting in SSA.…”

Pain in people living with HIV/AIDS: a systematic review

“…The remaining studies were conducted in the lower income countries of South Africa (five); Brazil (one); India (one); Vietnam (one); and Nigeria (one). The majority of the studies were conducted in urban settings with only one study reporting on a combination of rural and urban settings [35]. Sample sizes ranged from 50 participants in a single setting [12, 20] to nationally representative samples of 400 in Vietnam [37] and 2267 from the United States [24].…”

Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa

“…54 HIV-positive outpatients are no better off, with over 40% of ambulatory patients in pain not receiving any treatment, and of those patients who received treatment, less than 3% received drugs recommended for the treatment of NeuP, despite over a third of the patients having symptoms consistent with HIV-SN. 55 These studies highlight that the neuropathic component of HIV-related pain is probably poorly recognised and undertreated in South Africa.…”