Report of an HIV clinic-based pain management program and utilization of health status and health service by HIV patients

Johnson, Ahashta; Condon, Anp-Bc Kathleen DiGangi; Mapas-Dimaya, Ann Celeste; J, Schrager; Grossberg, Robert; Gonzalez, Ba Rosalyn; O’Mahony, Mb Sean

doi:10.5055/jom.2012.0092

Cited by 17 publications

(36 citation statements)

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“…It was conducted at one clinical site, which may limit generalizability to other settings, and was cross-sectional. Additionally, the database does not reliably include data about why opioids were prescribed, though we believe based on prior data from our cohort,(50) and from others (51, 52), that most chronic opioid therapy was prescribed for chronic non-malignant pain, primarily musculoskeletal and neuropathic.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV

et al. 2015

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Opioids are often prescribed for chronic pain, and opioid risks such as overdose and death are heightened when opioids are co-prescribed with other sedating medications. We investigated factors associated with chronic opioid prescription, alone and in combination with benzodiazepines and muscle relaxants, in a clinical cohort of individuals with HIV. We used multivariable logistic regression models to determine participant clinical and demographic characteristics that are associated with chronic prescription of opioids or chronic co-prescription of opioids with sedating medications. Among 1,474 participants, chronic prescription of opioids occurred in 253 individuals (17.2%), and chronic co-prescription occurred in 90 individuals (6.1%). Age >50, public insurance as compared to private insurance, and symptoms of depression and anxiety were significantly associated with chronic opioid prescription and chronic co-prescription. Our findings raise concern that opioid prescription and co-prescription of sedating medications occurs disproportionately in patients for whom use is riskier.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV

et al. 2015

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“…Os princípios desse tratamento envolvem cuidadosa titulação de opióides e adjuvantes analgésicos, além da administração programada (de horário) combinada com doses se necessário (1,3) . Por tais razões, o tratamento da dor na AIDS é baseado na pirâmide analgésica para o tratamento da dor no câncer (1,3,16) .…”

Section: (M7)unclassified

“…A dor é um desses sintomas, sendo o seu surgimento associado às alterações do sistema imunitário do indivíduo afetado pelo HIV, às infecções e às malignidades; sendo considerada, portanto, uma das sequelas mais comuns geradas da imunossupressão (1) . O predomínio desta dor varia dependendo do estágio da doença, dos cuidados e da metodologia de tratamento.…”

Section: Introductionunclassified

“…O predomínio desta dor varia dependendo do estágio da doença, dos cuidados e da metodologia de tratamento. Naqueles com a doença instalada (AIDS), os princípios de determinação e de tratamento da dor não são diferentes daqueles em pacientes com câncer, havendo aumento da dor conforme a doença progride (1) . Isto tem levado a uma dificuldade de controle dessa dor, geralmente atribuída aos complexos regimes antirretrovirais, aos riscos mais elevados de efeitos colaterais, às taxas mais altas de comorbidades psiquiátricas e ao abuso de substâncias por parte dos portadores da doença (2) .…”

Section: Introductionunclassified

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Chronic pain related to AIDS: perspective of nurses and doctors

Oliveira¹,

Silva²

2014

Revista Brasileira De Enfermagem

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RESUMOObjetivou-se identifi car as características e o manejo da dor crônica associada à síndrome da imunodefi ciência adquirida (AIDS) na perspectiva de enfermeiros e médicos. Estudo qualitativo realizado em hospital de referência de Fortaleza-CE, Brasil, com 20 profi ssionais. Aplicou-se entrevista semiestruturada e os discursos foram analisados pela técnica de análise de conteúdo de Bardin, emergindo três categorias: Caracterização da dor; Avaliação clínica da dor; e Cuidado Clínico da dor. Encontrou-se que a dor na AIDS manifesta-se como persistente, incapacitante e de difícil controle, sendo seu manejo baseado na identifi cação acurada dos fatores causais e na implementação do tratamento farmacológico e não farmacológico prestado pela equipe interdisciplinar. O estudo traz dados relevantes sobre a dor em pacientes com AIDS hospitalizados, demonstrando a necessidade de repensar o modelo gerencial de cuidado para promover intervenções de maior efi cácia analgésica e de aprimorar o atendimento interdisciplinar à dor para sua melhor avaliação e tratamento. Descritores: Enfermagem; Dor; Síndrome da Imunodefi ciência Adquirida; HIV; Pessoal de Saúde. ABSTRACTThe objective was to identify the features and the management of chronic pain associated to Acquired Immunodefi ciency Syndrome (AIDS) from the perspective of nurses and doctors. Qualitative study conducted at a reference hospital in Fortaleza-CE, Brazil, with 20 professionals. It was applied semi-structured interview and the speeches were analyzed using content analysis of Bardin, emerging three categories: Characterization of pain, Clinical evaluation of pain and Clinical care of pain. It was found that pain in AIDS manifests itself as persistent, disabling, with diffi cult control, and its management based on accurate identifi cation of the causal factors and on implementation of pharmacological and non pharmacological treatment offered by the interdisciplinary team. The study provides relevant data on pain in AIDS patients, demonstrating the need to rethink the model of care management interventions to promote greater effi cacy of analgesia and to improve interdisciplinary approach to pain for better pain evaluation and treatment. Key words: Nursing; Pain; Acquired Immunodefi ciency Syndrome; HIV; Health Personnel. RESUMENEl objetivo fue identifi car las características e el tratamiento del dolor crónico asociado con el síndrome de inmunodefi ciencia adquirida (SIDA) en la perspectiva de enfermeros y médicos. Estudio cualitativo realizado en hospital de referencia en Fortaleza-CE, Brasil, con 20 profesionales. Se aplicó entrevista semi-estructurada y los discursos fueron analizados utilizando análisis de contenido de Bardin, surgiendo tres categorías: Caracterización del dolor, Evaluación clínica del dolor y Cuidado clínico del dolor. Se encontró que el dolor en SIDA es persistente, incapacitante y difícil de controlar, su gestión es basada en la identifi cación precisa de los factores causales y en la aplicación del tratamiento farmacológico y no farmaco...

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“…1–3 In particular, chronic pain is common among PLWHA. 4,5 Causes of pain in persons living with HIV/AIDS (PLWHA) are many and include HIV’s direct effect on the nervous system causing neuropathy, side effects of antiretrovirals (ARVs), and other chronic conditions such as low back pain. 1,2,4,6 Pain is associated with several clinical outcomes in PLWHA, including functional impairment and ARV adherence.…”

Section: Introductionmentioning

confidence: 99%

Pain is Associated with Missed Clinic Visits Among HIV-Positive Women

et al. 2016

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Background Pain is highly prevalent among HIV-positive individuals, with women representing a large subset of those with pain. However, little is known about the relationship between pain and retention in HIV medical care. Among a cohort of HIV-positive women of color, we evaluated the association between pain and retention in care, as measured by missed clinic visits. Methods The Health Resources and Services Administration’s Women of Color Initiative was a multi-site observational cohort study evaluating demonstration projects to engage HIV-positive women in medical care. From November 2010 to July 2013, 921 women were enrolled in the study across nine U.S. sites; baseline interviews collected data on socio-demographic, clinical, and risk behavior characteristics. Pain was assessed at baseline based on number of days in pain over the last 30 days and was categorized as no pain (0 days), infrequent pain (1–13 days), and frequent pain (14–30 days), with 14 days being the median. Missed visits over the one-year follow-up period, evaluated by chart abstraction, were dichotomized as ≤1 missed visit vs. >1 missed visit. We conducted multivariate logistic regression to assess the association between pain at baseline and missed visits, adjusting for pertinent covariates. Results Among our sample (N=862), 52.2% of women reported no pain, 23.7% reported infrequent pain and 24.1% reported frequent pain. Forty-five percent had >1 missed visit during the one-year follow-up period. Overall, we did not find a significant association between pain and missed visits (aOR 2.30; 95% CI 1.00–5.25). However, in planned stratified analyses, among women reporting current substance use at baseline, reporting frequent pain was associated with a higher odds of missed visits as compared with reporting no pain (aOR=15.14; 95% CI 1.78–128.88). Conclusion In our overall sample, pain was not significantly associated with missed visits. However, frequent pain was associated with missed visits among HIV-positive women of color who reported substance use at baseline. A better understanding of the relationship between pain and missed visits could guide efforts to improve retention in care in this population.

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Report of an HIV clinic-based pain management program and utilization of health status and health service by HIV patients

Cited by 17 publications

References 0 publications

Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV

Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV

Chronic pain related to AIDS: perspective of nurses and doctors

Pain is Associated with Missed Clinic Visits Among HIV-Positive Women

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