Pain in people living with HIV and its association with healthcare resource use, well being and functional status

Abstract

Objective: We describe the prevalence of pain and its associations with healthcare resource utilisation and quality-of-life. Design: The POPPY Study recruited three cohorts: older PLWH (≥50 years, n=699), younger demographically/lifestyle similar PLWH (<50 years, n=374) and older demographically/lifestyle similar HIV-negative (≥50 years, n=304) people from April 2013-February 2016. Methods: Current pain and pain-related healthcare use was collected via a self-reported questionnaire. Logistic regression assessed between-group differences in the prevalence of pain in the past month and current pain after controlling for potential confounders. Associations between current pain and healthcare resource use, reported joint problems, depressive symptoms, quality-of-life and functional status were assessed in PLWH using Mann-Whitney U and Chi-squared tests. Results: Pain in the past month was reported by 473/676 (70.0%) older PLWH, 224/357 (62.7%) younger PLWH and 188/295 (63.7%) older HIV-negative controls (p=0.03), with current pain reported in 330 (48.8%), 134 (37.5%) and 116 (39.3%), respectively (p=0.0007). Older PLWH were more likely to experience current pain, even after adjustment for confounders. Of those with pain in the past month, 56/412 (13.6%) had missed days of work or study due to pain, and 520 (59%) had seen a doctor about their pain. PLWH experiencing current pain had more depressive symptoms, poorer quality-of-life on all domains, and greater functional impairment, regardless of age group. Conclusions: Even in the effective ART era, pain remains common in PLWH and has a major impact on quality-of-life and associated healthcare and societal costs. Interventions are required to assist clinicians and PLWH to proactively manage pain.

Impact of musculoskeletal symptoms on physical functioning and quality of life among treated people with HIV in high and low resource settings: A case study of the UK and Zambia

“…Individuals with musculoskeletal pain are less likely to be in work than those without a health problem and are also more likely to retire early. The direct cost to the economy on days lost of work can be substantial as those affected by pain syndromes are more likely to utilize healthcare services and require drug prescriptions to control the symptoms [44]. Longitudinal studies in high- and low-income settings investigating the contributors of musculoskeletal pain are needed to inform the development of effective interventions to prevent and managed those with musculoskeletal symptoms living with HIV.…”

Chronic Pain in People with HIV: A Common Comorbidity and Threat to Quality of Life

“…The clinical care of HIV is more likely to be compromised when PWH have chronic pain. Suboptimal treatment adherence and retention in care are more frequent in PWH and chronic pain [ 29 , 30 ], placing them at higher risk of viral rebound and worse long-term health outcomes. Societal interactions also suffer given some PWH and chronic pain report that the pain limits their willingness to engage in social activities [ 26 ].…”

“…Societal interactions also suffer given some PWH and chronic pain report that the pain limits their willingness to engage in social activities [ 26 ]. Chronic pain is also linked to lower economic participation: one UK/Ireland-based study found that PWH and chronic pain are less likely than their matched, pain-free peers to be working full-time, and more likely to be unemployed or on sick leave [ 30 ]. Despite this growing body of evidence demonstrating the widespread negative consequences of chronic pain in PWH, the problem remains largely underappreciated and undertreated.…”

Avaliação da dor e fatores associados em pessoas que vivem com HIV/AIDS

“…On the interference of pain in the daily life of PLWHA, in the present study, it was observed that the activities that suffered the most intense interference were mood, followed by daily activity and, finally, general activity. The literature shows high interference of pain in daily life, especially in sleep aspects, life enjoyment, and work of PLWHA ( 15 , 21 – 22 ) .…”

“…The direction of the relationship between pain and depression can be reciprocal as it is likely that those who experience pain become depressed and those who are depressed may be more likely to report pain. In addition, changes in the central nervous system of PLWHA associated with depression may influence the evolution of the disease, since they contribute to the increase of biological vulnerability ( 22 – 25 ) .…”