Pain in ambulatory AIDS patients. I: Pain characteristics and medical correlates

Breitbart, William; McDonald, Margaret; Rosenfeld, Barry; Passik, Steven D.; Hewitt, David; Thaler, Howard T.; Portenoy, Russell K.

doi:10.1016/s0304-3959(96)03215-0

Cited by 185 publications

(196 citation statements)

References 15 publications

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“…The present results are consistent with prior research indicating increased pain report among IDUs with HIV (Fantoni et al 1997;Martin et al 1999;Vogl et al 1999;Del Borgo et al 2001). However, our findings are inconsistent with reports that found no differences in pain report in HIV+ IDUs and non-IDUs (Breitbart et al 1996a;Breitbart et al 1997). One possibility is that overall, the Breitbart samples had more advanced disease-i.e., roughly 70% met criteria for AIDS, whereas only 36.3% of the HCSUS sample met criteria for AIDS.…”

Section: Discussioncontrasting

confidence: 99%

“…It was a latent variable indicated by 2 items: 1) The respondent's clinical category based upon AIDS diagnoses: 1 = asymptomatic/PGL (persistent generalized lymphadenopathy); 2 = symptomatic; 3 = AIDS indicator condition; and 2) Whether the respondent had wasting syndrome (1 = no; 2 = yes). CD4 count was not included because prior work indicated no relationship between CD4 and pain in HIV+ individuals (Breitbart et al 1996a;). …”

Section: Questionnaire Itemsmentioning

confidence: 99%

“…Lack of adequate care may therefore contribute to an increased burden of HIV disease which in turn may result in greater pain. Prior studies in convenience samples however, have yielded mixed findings: some found that IDUs with HIV report more pain than non-IDUs (Fantoni et al 1997;Martin et al 1999;Vogl et al 1999;Del Borgo et al 2001), whereas others found no differences in reported pain (Breitbart et al 1996a;Breitbart et al 1997). In our research with a representative U.S. sample of HIV+ persons, we found that women, but not men, exposed to HIV via IV-drug use reported more pain compared to men who have sex with men (MSM) ).…”

mentioning

confidence: 99%

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Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV

Tsao

Dobalian

Stein

2005

Pain

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We investigated predictive and concurrent relationships among reported pain, HIV/AIDS illness burden, and substance use history in 2,267 participants in the longitudinal HIV Cost and Services Utilization Study (HCSUS). Substance use history was classified as screening positive for current illicit drug use (N = 253), past drug use (N = 617), and non-user (N = 1397) at baseline. To control for demographic correlates, age, sex and socioeconomic status (SES) were included as predictors. Covariance structure models indicated greater pain at baseline among participants acknowledging current substance use. Pain at baseline was also directly predicted by greater HIV/AIDS illness burden, lower SES, and older age. At 6 months, pain was directly predicted by prior pain, worse concurrent HIV/AIDS illness burden and female sex. At 12 months, pain was predicted by older age, prior pain, and concurrent HIV/AIDS illness. It was also modestly but significantly predicted by current substance use at baseline. In addition to the direct effects on pain, there were significant indirect effects of demographic and drug use variables on pain mediated through HIV/AIDS illness burden and prior pain. There were significant and positive indirect effects of current and past drug use, greater age, and lower SES on pain at all three time periods. Pain at 6 months and pain at 12 months were also indirectly impacted by previous illness burden. Our results indicate that HIV+ persons who screened positive for current use of a range of illicit substances experienced greater HIV/AIDS illness burden which in turn predicted increased pain.

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Section: Discussioncontrasting

confidence: 99%

Section: Questionnaire Itemsmentioning

confidence: 99%

mentioning

confidence: 99%

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Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV

Tsao

Dobalian

Stein

2005

Pain

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“…Our findings are consistent with prior work demonstrating that HIV+ patients who are injection drug users (IDUs) report more pain than non-IDUs (Fantoni et al 1997;Martin et al 1999;Vogl et al 1999;Del Borgo et al 2001), although null findings have also been reported (Breitbart et al 1996a;Breitbart et al 1997). Previously, we found that patients with problematic drug use history experienced greater HIV/AIDS illness burden, which in turn predicted greater pain (Tsao et al 2005).…”

Section: Discussionsupporting

confidence: 92%

Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

Tsao

Stein²,

Dobalian

2007

Pain

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Little is known about the relationship between pain and aberrant use of prescription analgesics in persons living with HIV. We examined the predictive and concurrent associations among pain, aberrant use of opioids, and problem drug use history in a nationally representative longitudinal sample of 2267 HIV+ persons. Covariance structure analyses tested a conceptual model wherein HIV + patients with a history of problematic drug use (n = 870), compared to those without such history (n = 1397), were hypothesized to report more pain and aberrant opioid use, as well as use of opioids specifically for pain at baseline and 6 and 12 month follow-ups, after controlling for key sociodemographic characteristics. In support of the hypothesized model, patients with a history of problematic drug use reported more pain, and were more likely to report aberrant use of prescription analgesics, as well as use of such medications specifically for pain, compared to patients without such history. We also found a trend toward greater stability of aberrant opioid use over time in problem drug users compared with non-problem users suggesting a persistent pattern of inappropriate medication use in the former group. Our findings suggest that even though HIV+ persons with a history of problematic drug use report on-going patterns of using prescription analgesics specifically for pain, these patients continued to experience persistently higher levels of pain, relative to nonproblem users. Among non-problem users, pain was not linked to aberrant use of opioids, but was linked to the use of such medications specifically for pain.

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“…Several other studies in treatment-seeking, chronic pain populations have reported a similar pattern of results (Edwards et al 2005;Green et al 2003;McCracken et al 2001;Edwards et al, 1999;Greenwald, 1991). Additional evidence indicates ethnic differences in the severity of pain associated with several medical conditions, including AIDS (Breitbart et al 1996), glaucoma (Sherwood et al 1998), and arthritis (Creamer et al 1999). …”

Section: Introductionmentioning

confidence: 99%

Ethnic identity predicts experimental pain sensitivity in African Americans and Hispanics

Rahim-Williams¹,

Riley²,

Herrera³

et al. 2007

Pain

224

169

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The aim of this study was to examine experimental pain sensitivity in three ethnic groups, African Americans, Hispanic Americans and non-Hispanic whites, and to determine whether ethnic identity is differentially associated with pain sensitivity across ethnic groups. Participants included sixtythree African American, sixty-one Hispanic and eighty-two non-Hispanic white participants who were assessed using three experimental pain measures: thermal, cold-pressor and ischemic. Participants' ethnic identity was assessed using the Multi-group Ethnic Identity Measure (MEIM). Ethnic group differences in pain responses were observed, with African American and Hispanic subjects showing lower cold and heat pain tolerances than non-Hispanic whites. In addition, pain range (i.e. tolerance -threshold) was computed for heat, cold and ischemic pain, and the two minority groups again had lower values compared to non-Hispanic whites. Ethnic identity was associated with pain range only for African American and Hispanic groups. Statistically controlling for ethnic identity rendered some of the group differences in pain range non-significant. These findings indicate that ethnic identity is associated with pain sensitivity in ethnic minority groups, and may partially mediate group differences in pain perception. The results of the present investigation provide evidence of ethnic group differences in responses to experimental pain across multiple noxious stimuli, with both minority groups exhibiting greater sensitivity to laboratory evoked pain compared to non-Hispanic whites.

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Pain in ambulatory AIDS patients. I: Pain characteristics and medical correlates

Cited by 185 publications

References 15 publications

Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV

Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV

Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

Ethnic identity predicts experimental pain sensitivity in African Americans and Hispanics

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