Pain is associated with heroin use over time in HIV ‐infected R ussian drinkers

Self Cite

Background Pain is highly prevalent among persons with HIV. Alcohol may be used to “self-medicate” pain. This study examined the association between pain and risky alcohol use over time in a cohort of HIV-infected Russian drinkers. Methods This secondary analysis utilized longitudinal data from a randomized trial of a behavioral intervention. Subjects included HIV-infected adults who reported past 6-month risky drinking and unprotected sex and were recruited from HIV and addiction treatment sites in St. Petersburg, Russia. The main independent variable was pain that at least moderately interfered with daily living. The primary outcome was past month risky drinking amounts based on NIAAA guidelines. General estimating equations (GEE) logistic regression models were used to calculate odds ratios and 95% confidence intervals for the association between pain and risky drinking over time (i.e., baseline, 6- and 12-months), adjusting for potential confounders. Results Baseline characteristics of participants (n=699) were mean age of 30 (SD±5) years, 41% female, and 22% < 9th grade education. Nearly one quarter (24%) had a CD4 cell count <200 cells/μ/l, and only 17% were on antiretroviral therapy. Nearly half (46%) reported at least moderate pain interference in the past month and 81% were drinking risky amounts. In adjusted longitudinal GEE models, pain was significantly associated with greater odds of reporting past month risky drinking (AOR=1.34, 95% CI: 1.05-1.71, p-value=0.02). Conclusions Among a cohort of HIV-infected Russian drinkers, pain that at least moderately interfered with daily living was associated with higher odds of reporting risky drinking amounts over time.

Section: Introductionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 83%

Pain is associated with risky drinking over time among HIV-infected persons in St. Petersburg, Russia

Tsui¹,

Cheng²,

Coleman³

et al. 2014

Self Cite

“…Chronic pain is highly relevant to substance use outcomes, as it may serve as a barrier to treatment entry, retention or success, and a trigger for relapse. Among HIV-infected substance users, pain has been associated with persistent use of heroin (Tsui et al, 2013). In some studies, patients with chronic pain who received addiction treatment were more likely to relapse to drug use compared to patients without pain (Caldeiro et al, 2008; Larson et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Chronic pain, craving, and illicit opioid use among patients receiving opioid agonist therapy

Tsui

Lira

Cheng

et al. 2016

Self Cite

Aims In a sample of patients receiving opioid agonist therapy, we evaluated whether having chronic pain was associated with a) craving for opioids and b) illicit opioid use. Methods In a cross-sectional study of adults on buprenorphine or methadone maintenance recruited from an urban medical center, we examined any craving for opioids (primary dependent variable) in the past week and recent illicit opioid use (secondary dependent variable). Illicit opioid use was defined as a positive urine drug test (UDT) for opiates and chronic pain was defined as bodily pain that had been present for at least 3 months. Multivariable logistic regression models were fit for each outcome, adjusting for age, sex, and non-white race. Additional models adjusted for depression (PHQ-9) and anxiety (STAI). Results The sample included 105 adults on methadone or buprenorphine maintenance. Mean age was 43.8 (SD±9.4) years; 48% were female and 32% non-white; 19% were on methadone. Chronic pain was present in 68% of the sample, 51% reported craving opioids in the past week, and 16% had a positive UDT. Chronic pain was associated with 3-fold higher odds of reporting craving in the past week (aOR=3.10; 95% CI: 1.28–7.50, p-value=0.01). The relative odds for having a positive UDT were not statistically significant (aOR=2.52; 95% CI: 0.64–9.90, p=0.18). Conclusion In this sample of patients treated with opioid agonist therapy, those with chronic pain had higher odds of reporting craving for opioids. Chronic pain with associated opioid craving potentially places this population at risk for relapse.

“…The prevalence of chronic pain among persons with opioid use disorders treated with opioid agonist therapy (OAT) ranges from 36 to 61% (Barry et al, 2009, 2013; Jamison et al, 2000; Rosenblum et al, 2003). Chronic pain is problematic for patients with substance use disorders as it has been associated with risk for persistent heroin use (Potter et al, 2010; Tsui et al, 2013) and relapse to use of drugs and alcohol (Larson et al, 2007). However, treatment for opioid use disorders with OAT can lead to alterations in pain sensitivity leading to hyperalgesia.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C virus infection and pain sensitivity in patients on methadone or buprenorphine maintenance therapy for opioid use disorders

Tsui

Lira

Cheng

et al. 2015

Self Cite

Background Patients with opioid use disorders on opioid agonist therapy (OAT) have lower pain tolerance compared to controls. While chronic viral infections such as HCV and HIV have been associated with chronic pain in this population, no studies have examined their impact on pain sensitivity. Methods We recruited 106 adults (41 uninfected controls; 40 HCV mono-infected; and 25 HCV/HIV co-infected) on buprenorphine or methadone to assess whether HCV infection (with or without HIV) was associated with increased experimental pain sensitivity and self-reported pain. The primary outcome was cold pain tolerance assessed by cold-press or test. Secondary outcomes were cold pain thresholds, wind-up ratios to repetitive mechanical stimulation (i.e., temporal summation) and acute and chronic pain. Multivariable regression models evaluated associations between viral infection status and outcomes, adjusting for other factors. Results No significant differences were detected across groups for primary or secondary outcomes. Adjusted mean cold pain tolerance was 25.7 (uninfected controls) vs. 26.8 (HCV mono-infection) vs. 25.3 (HCV/HIV co-infection) seconds (global p-value=0.93). Current pain appeared more prevalent among HCV mono-infected (93%) compared to HCV/HIV co-infected participants (76%) and uninfected controls (80%), as did chronic pain (77% v. 64% v. 61% respectively). However, differences were not statistically significant in multivariable models. Conclusion This study did not detect an association between HCV infection and increased sensitivity to pain among adults with and without HIV who were treated with buprenorphine or methadone for opioid use disorders. Results reinforce that pain and hyperalgesia are common problems in this population.