The mediating role of pain in substance use and depressive symptoms among Multicenter AIDS Cohort Study (MACS) participants

Abstract

Pain in HIV frequently co-occurs with substance use and depression. The complex associations among patient characteristics, pain, depression, and drug use in HIV suggests a role for testing models that can account for relationships simultaneously, control for HIV status and also test for mediation. Using structural equation modeling (SEM), the current study examined associations among pain, sociodemographics, illicit drug use and depressive symptoms in 921 HIV seropositive and 1,019 HIV seronegative men from the Multicenter AIDS Cohort Study (MACS), an ongoing prospective study of the natural history of HIV infection among gay/bisexual men. Longitudinal repeated measures data collected over a 6 year period were analyzed using predictive path models in which sociodemographics, HIV status and CD4+ cell counts predicted pain which in turn predicted depressive symptoms and illicit drug use. The path models did not differ substantially between HIV seropositive and seronegative men. Analyses using the total sample indicated that pain served both as a mediator and as a predictor of more use of cannabis, cocaine and heroin, as well as more depressive symptoms. HIV seropositive status predicted more use of inhaled nitrites. In this cohort, having lower CD4+ cell counts (predicted by HIV status), being African-American, less educated, and older were all associated with more pain which in turn was associated with more illicit drug use and more depressive symptoms. The results underscore the need for adequate pain management, particularly among vulnerable subgroups of HIV seropositive and HIV seronegative men to reduce the risk of drug use and depression.

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

“…A study of 1,940 HIV-infected men in the United States found that pain was significantly associated with cannabis and hard drug use defined as cocaine or heroin use (Tsao et al, 2011), and we previously reported an association between pain and heroin use in this same Russian sample (Tsui et al, 2013). A prior study conducted in a population of homeless, HIV-infected persons in San Francisco that examined bivariate associations between substance use and pain severity did not find differences in the proportion reporting current daily drinking among pain severity categories (Miaskowski et al, 2011).…”

“…Studies conducted in non-HIV infected persons have reported use of alcohol in response to pain (Brennan et al, 2005; Riley and King, 2009). In one study of HIV-infected men, pain was found to be significantly associated with illicit drug use and depression (Tsao et al, 2011). Because unhealthy alcohol use is related to HIV-related sexual and drug risk behaviors (Shuper et al, 2009; Wen et al, 2012), non-adherence to HIV medications (Arnsten et al, 2002; Azar et al, 2010; Chander et al, 2006; Cohn et al, 2011; Golin et al, 2002; Howard et al, 2002) and lack of viral suppression (Azar et al, 2010; Lucas et al, 2002; Palepu et al, 2003; Samet et al, 2007; Wu et al, 2011), understanding whether pain is associated with alcohol use is especially relevant in this population.…”

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

“…However, another study of veterans initiating methadone for treatment of opioid dependence did not find baseline pain to be predictive of substance-use related outcomes at one year [25]. In the one study identified among HIV-infected persons, the relationships between pain and substance use in a cohort of 1,940 men in the U.S. found that pain was significantly associated with cannabis and hard drug use (defined as cocaine or heroin use) [26]. Our study supports the hypothesis that pain can impact substance use patterns over time in HIV-infected men and women, and provides information to suggest that the relationship between pain and heroin use may be unique, as compared to other illicit drugs.…”

Depression and Sexual Dysfunction Among HIV-Positive and HIV-Negative Men Who Have Sex With Men: Mediation by Use of Antidepressants and Recreational Stimulants

“…1). This approach has been conducted and published in other longitudinal analyses of the MACS to account for any possible cohort effect (Shoptaw et al, 2012; Tsao, Stein, Ostrow, Stall, & Plankey, 2011). …”