Pain, Mood, and Substance Abuse in HIV: Implications for Clinic Visit Utilization, ART Adherence, and Virologic Failure (S701)

Merlin, Jessica S.; Westfall, Andrew O.; Raper, James E.; Zinski, Anne; Norton, Wynne E.; Willig, James H.; Gross, Robert; Ritchie, Christine; Saag, Michael S.; Mugavero, Michael J.

doi:10.1016/j.jpainsymman.2012.10.118

Cited by 42 publications

(67 citation statements)

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“…Central sensitization is particularly important in this group because a significant proportion of PLWHA abuse alcohol. Unfortunately, research in this area is still limited and highly debated [5][6][7][8], as it is unclear if: a) pain becomes a problem because pain thresholds are lowered in alcohol users when they are sober, or b) if these individuals are using increased amounts of alcohol looking for ethanol's potential analgesic effects or c) if pain is related to the subject's expectancies or mood.…”

Section: Introductionmentioning

confidence: 99%

HIV, Alcohol Use Disorders and Pain: New Findings to Address the Problem

Mj¹,

Espinoza²,

Perez³

et al. 2017

J HIV Retrovirus

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Section: Introductionmentioning

confidence: 99%

HIV, Alcohol Use Disorders and Pain: New Findings to Address the Problem

Mj¹,

Espinoza²,

Perez³

et al. 2017

J HIV Retrovirus

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“…[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.…”

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confidence: 99%

“…5,[8][9][10] Despite these indicators, recent literature suggests that pain is often under-recognized and under-treated in clinical care for HIV-positive individuals. 11,12 Many HIV-positive individuals suffer from co-morbid mood disorders and/or substance abuse problems, 3 and pain management among these patients can present special challenges. 12 In particular, the risk for medication misuse may be heightened, 13 and patients may require close monitoring; likewise, the under-treatment of pain may lead to aberrant drug-seeking behaviors.…”

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confidence: 99%

“…10 Despite these challenges, balanced and appropriate pain management among vulnerable HIV patients is critical to both individual and public health. 7 A small but emerging body of literature suggests that pain experience among HIV-positive patients is associated with poor ARV adherence and reduced attendance at HIV-related care visits, 2,3,14 both of which are key behavioral components of disease management to achieve viral suppression and prevent onward transmission. 15,16 Although a handful of other studies has shown no link between pain and ARV treatment adherence, 1,13 the dearth of research on this topic precludes consensus.…”

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confidence: 99%

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

Surratt

Kurtz

Levi-Minzi

et al. 2015

AIDS Patient Care and STDs

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Pain represents a significant source of morbidity, function loss, and decreased quality of life among people living with HIV. The present study examined the associations among pain, pain treatment, and ARV adherence among indigent, HIV-positive substance abusers. Participants were recruited via targeted sampling strategies, and completed a one-time computer-assisted personal interview. ANOVA and chi-square tests were used to analyze differences in demographics, health and psychological status, health behaviors, by pain and pain treatment status; a multivariate logistic regression model was constructed to examine the contribution of pain/ treatment status to recent ARV adherence. Results indicated that those with untreated pain had lower odds of achieving gold-standard 95% ARV adherence as compared to the pain-free and treated pain groups; higher substance dependence symptoms were also associated with significantly lower odds of 95% ARV adherence. Findings suggest that pain management is critical to the health of people living with HIV, specifically those with high levels of co-morbid health and psychological problems. The prevalence of untreated pain was elevated among this group, and contributed to reduced ARV adherence. Providers of clinical care to disadvantaged HIV-positive patients should emphasize routine assessment and appropriate treatment of pain in order to provide comprehensive HIV care.

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“…17 Most studies of chronic pain prevalence in HIV-infected patients rely on queries pertaining to short time frames (1 day to 1 month), [5][6][7][8][9][10][11][12][13] or methods of screening for chronic pain that have not been validated in any clinical population. 13 Furthermore, well-validated pain questionnaires, such as the Brief Pain Inventory 18 and Multidimensional Pain Inventory, 19 have been used to study pain in patients with HIV, [5][6][7][8][9][10][11][12][13] but are not designed as screeners. As detailed questionnaires, they were designed to understand pain's impact on physical and emotional function in patients already known to have a pain condition, whether acute or chronic.…”

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confidence: 99%

Qualitative Investigation of a Brief Chronic Pain Screening Tool in HIV-Infected Patients

Merlin

Walcott

Herbey

et al. 2014

AIDS Patient Care and STDs

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Chronic pain in HIV-infected patients is prevalent but understudied. A limitation of HIV/chronic pain research to date is the lack of a widely used chronic pain screening tool. A Brief Chronic Pain Screening tool (BCPS) has been described, but has not yet been tested in a clinical population. This study sought to evaluate how the BCPS is experienced by HIV-infected individuals, and adapt its questions if necessary. We conducted cognitive interviews using cognitive inquiry in participants from the UAB 1917 HIV Clinic Cohort. Data were analyzed using a process of inductive, iterative coding by three investigators. Results: Of 30 participants, most were male, African American, and less than 50 years old. Participants reported that the questions were understandable; however, feedback suggested concerns regarding lack of specificity in regard to the intensity and consistency of pain. An introductory statement aimed at improving clarity resulted in more divergent responses. This research team concluded that the version of the BCPS used in the first 30 interviews was optimum. Its inclusive language allows the respondent to decide what pain merits reporting. This study is the first investigation of the BCPS in a clinical population, and should lead to further quantitative validation studies of this tool.

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Pain, Mood, and Substance Abuse in HIV: Implications for Clinic Visit Utilization, ART Adherence, and Virologic Failure (S701)

Cited by 42 publications

References 0 publications

HIV, Alcohol Use Disorders and Pain: New Findings to Address the Problem

HIV, Alcohol Use Disorders and Pain: New Findings to Address the Problem

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

Qualitative Investigation of a Brief Chronic Pain Screening Tool in HIV-Infected Patients

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