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

Abstract

IntroductionPain is one of the most commonly reported symptoms in people living with HIV/AIDS (PLWHA). However, wide ranges of pain prevalence have been reported, making it difficult to determine the relative impact of pain in PLWHA. A systematic review of the literature was conducted to establish the prevalence and characteristics of pain and to explore pain management in PLWHA.MethodsStudies that included cross-sectional data were included in the search, which was conducted in April 2012. Databases searched using a time limit of March 1982 to March 2012 included PubMed, Scopus, Africa-wide: NIPAD, CINAHL, PsychARTICLES, PSYCINFO, PSYCHIATRYONLINE, ScienceDirect and Web of Science. Search terms selected were “pain” and “HIV” or “acquired immune deficiency syndrome.” Two reviewers independently screened all citation abstracts for inclusion. Methodological quality was evaluated using a standardized 11-item critical appraisal tool.ResultsAfter full text review, 61 studies fulfilled the inclusion criteria. Prevalence of pain ranged from a point prevalence of 54% (95%CI 51.14–56.09) to 83% (95%CI 76–88) using a three-month recall period. The reported pain was of moderate-to-severe intensity, and pain was reported in one to two and a half different anatomical sites. Moderate levels of pain interference with function were reported. All nine studies reporting on the adequacy of pain management recorded marked under-treatment of pain.DiscussionThe studies reviewed reported that pain commonly presents at multiple pain sites with a range of severity suggesting that there are several differing pathological processes contributing to pain at one time. The interplay of variables associated with pain suggests that the biopsychosocial model of pain is an appropriate paradigm from which to view pain in PLWHA and from which to approach the problem, explore causes and establish effective treatment.ConclusionsThe results highlight that pain is common in PLWHA at all stages of the disease. The prevalence rates for pain in PLWHA do not appear to have diminished over the 30 years spanning the studies reviewed. The body of work available in the literature thus far, while emphasizing the problem of pain, has not had an impact on its management.

Pain Treatment and Antiretroviral Medication Adherence Among Vulnerable HIV-Positive Patients

“…Although elevated with respect to the general population, this finding is in line with prior research on HIV-positive patients, which has gauged pain prevalence to be between 40% and 80%. [1][2][3][4] Our data confirm that pain is an exceedingly common co-morbid health condition among HIV-positive individuals, including the non-elderly and those treated in an era of ARVs with lower side effect profiles. Although this study did not gather information on pain intensity or duration, prescribed pharmacotherapy to treat pain was modest, with 41.5% of those endorsing pain being untreated.…”

“…[1][2][3][4] The etiology of pain among HIV-positive individuals is varied, and includes infection-related inflammatory responses, secondary complications of progressive HIV disease, as well as adverse effects of treatment with antiretroviral (ARV) medications. 5 Sensory neuropathy, for example, has been estimated to affect 40-60% of treated HIV-positive individuals, 6 and often results in moderate to severe pain.…”

P2Y12 receptor upregulation in satellite glial cells is involved in neuropathic pain induced by HIV glycoprotein 120 and 2′,3′-dideoxycytidine

“…The direct neurotoxicity of HIV and the neurotoxic effects of combination antiretroviral therapy medications are both thought to contribute to the development of HIV distal symmetric polyneuropathy [1][2][3]. Glycoprotein 120 (gp120) is involved in the indirect neurotoxic effects of HIV on the peripheral nervous system [2,[4][5][6]. As one type of neurotoxic combination antiretroviral therapy drugs, nucleoside analog reversetranscriptase inhibitors have been shown to be associated with distal symmetric polyneuropathy [1,3,7].…”

“…Distal symmetric polyneuropathy has been recognized as one of the most common neurologic complications of HIV [1][2][3]. The direct neurotoxicity of HIV and the neurotoxic effects of combination antiretroviral therapy medications are both thought to contribute to the development of HIV distal symmetric polyneuropathy [1][2][3]. Glycoprotein 120 (gp120) is involved in the indirect neurotoxic effects of HIV on the peripheral nervous system [2,[4][5][6].…”

Updates in Psychosomatic Medicine: 2014

“…The articles were Updates in Psychosomatic Medicine related to 15 subspecialties: cardiac psychiatry, [4][5][6][7][8][9] collaborative care/integrated behavioral health, 10,11 emergency psychiatry, 12,13 HIV psychiatry, [14][15][16][17][18][19][20] neuropsychiatry, 21-31 pediatric psychosomatic medicine, 32-36 psychodermatology, [37][38][39][40][41][42][43][44][45] psychonephrology, 46-55 psycho-oncology and palliative care, [56][57][58][59][60][61][62][63][64] serious mental illness, [65][66][67][68][69][70][71][72] somatic symptom disorders, 73 suicide, 74-78 transplant psychiatry, [79][80][81][82][83][84]…”