Social support buffers the negative influence of perceived injustice on pain interference in people living with HIV and chronic pain

Abstract

Introduction: A growing literature attests to the overwhelming prevalence of disabling chronic pain among people living with HIV (PLWH), yet very little is known about psychosocial contributors to poor chronic pain outcomes in this population. Pain-related perception of injustice may promote pain interference by hindering engagement in daily activities among individuals with chronic pain. Social support has been shown to buffer the negative impact of harmful beliefs on well-being and facilitate adjustment to chronic pain. Objective: This cross-sectional study tested the buffering hypothesis of social support to determine whether increasing levels of social support mitigate the negative influence of perceived injustice on pain interference. Methods: A total of 60 PLWH with chronic pain completed measures of perceived injustice, social support, pain severity, and interference, as well as depressive symptoms. Results: In a regression-based model adjusted for age, sex, depressive symptoms, and pain severity, results indicated that social support significantly moderated (ie, buffered) the association between perceived injustice and pain interference ( P = 0.028). Specifically, it was found that perceived injustice was significantly associated with greater pain interference among PLWH with low levels of social support ( P = 0.047), but not those with intermediate ( P = 0.422) or high levels of social support ( P = 0.381). Conclusion: Pain-related injustice perception reflects harmful beliefs regarding severity of loss consequent to chronic pain development, a sense of unfairness, and irreparability of loss. Access to a social support network may provide an adaptive means of mitigating the negative effects of perceived injustice.

The psychosocial context of chronic pain in people living with HIV

“…The study by Penn et al in this issue brings needed attention to the psychosocial context of chronic pain in people living with HIV (PLWH) in the current treatment era. 17 As PLWH age and have normal life expectancy with antiretroviral therapy (ART), quality of life is now a focus. 9,15 Chronic pain, as highlighted by Penn et al, is a major threat to functioning and quality of life in PLWH.…”

“…20 In their cross-sectional, questionnaire-based study, Penn et al found that perceptions of pain-related injustice (ie, appraisals of loss, unfairness, and blame) were associated with greater pain interference in PLWH; however, high levels of social support attenuated this association. 17 Although they did not directly assess stigma, the authors argue that stigma related to HIV and the pain itself, particularly when not attributed to clear pathology, might give rise to appraisals of one's situation as unjust. 17…”

“…17 Although they did not directly assess stigma, the authors argue that stigma related to HIV and the pain itself, particularly when not attributed to clear pathology, might give rise to appraisals of one's situation as unjust. 17…”

“…Following from their findings, Penn et al 17 identify that efforts to enhance social support may improve pain outcomes among people with HIV and chronic pain. In particular, they suggest that fostering a strong therapeutic alliance may help to mitigate the impact of low social support.…”

“…In particular, they suggest that fostering a strong therapeutic alliance may help to mitigate the impact of low social support. 17 The therapeutic alliance is of course important for improving pain management outcomes. 7 There is also preliminary evidence that perceived injustice is associated with disruptions in the working alliance among people with chronic pain attending multidisciplinary rehabilitation.…”