‘Two Pains Together’: Patient Perspectives on Psychological Aspects of Chronic Pain while Living with HIV

Merlin, Jessica S.; Walcott, Melonie; Ritchie, Christine S.; Herbey, Ivan; Kertesz, Stefan G.; Chamot, Eric; Saag, Michael S.; Turan, Janet M.

doi:10.1371/journal.pone.0111765

Cited by 24 publications

(24 citation statements)

References 40 publications

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“…Patients in this population seek alternatives—such as rationing practices, using non-prescription opioids, and going to the emergency department for prescriptions (20)—which pose threats to patients, such as worsening of pain, negative drug interactions, misuse, overdose, withdrawal, and lack of continuity of care.…”

Section: Discussionmentioning

confidence: 99%

“…A growing number of studies highlight the challenges surrounding chronic pain management in populations living with HIV or those with drug use disorders, specifically regarding its impact on well-being and patients’ use of self-management strategies (20–22). The objective of the present study was to explore patients’ experiences with providers regarding clinical pain management, as well as patients’ access to and use of prescription opioid analgesics.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders

Isenberg¹,

Maragh-Bass²,

Ridgeway³

et al. 2017

J of Opioid Management

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Objective The study explored high risk participants’ experiences with pain management regarding clinical access to and use of prescription opioids. Design Qualitative semi-structured interviews and focus groups. Setting Data was collected August 2014 to May 2015 at an urban community-based research facility in Baltimore City, MD. Participants HIV participants with chronic pain and a history of illicit drug use. Methods Qualitative coding and analysis used an iterative, inductive and thematic approach and coders achieved inter-coder consistency. Results We identified two major themes. First, participants had positive and negative interactions with health care providers regarding chronic pain treatment. Participants perceived providers lacked empathy for their pain and/or were not adequately managing their pain. These interactions resulted in participants seeking new providers or mistrusting the medical system. Further, providers’ surveillance of participants’ pain treatment regimen contributed to distress surrounding pain management. The second theme centered on participants’ pain management experiences with prescribed opioid analgesics. Participants felt they were receiving dosages and classes of analgesics that did not sufficiently address their pain, and consequently modified their dosages or rationed prescription opioids. Other participants were reluctant to take analgesics due to their history of illicit drug use. Some participants relapsed to illicit drug use when they felt their prescription opioids did not adequately address their pain needs. Conclusions Participant struggles with receiving and managing prescribed opioid analgesics suggest a need for: therapies beyond these medications; guidelines for providers specific to this population; and harm reduction trainings for providers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders

Isenberg¹,

Maragh-Bass²,

Ridgeway³

et al. 2017

J of Opioid Management

View full text Add to dashboard Cite

show abstract

“…Our findings are similar to what has been observed in other studies, including some research from settings that could be considered higher-risk than this two-site sample. Prescription opioids treat pain, and in US studies, 39–85% of people living with HIV report pain (Merlin, 2014). In one study of indigent HIV-positive adults in California, 53% had received an opioid prescription in the prior 90 days (Jeevanjee, 2014).…”

Section: Discussionmentioning

confidence: 99%

High levels of self-reported prescription opioid use by HIV-positive individuals

et al. 2016

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Prescription medication use (other than antiretroviral therapy (ART)) is highly prevalent among people living with HIV. Prescription medications may be used medically or non-medically: non-medical use includes using more medication than prescribed, using medication prescribed to someone else, or using medication for a purpose other than its prescribed use. During 12 weeks in 2014–15, we characterized medical and non-medical prescription medication use among HIV-positive patients attending an academic medical center (n=149) and a community clinic (n=105). Separately for the past year and the past month, these 254 participants self-reported their use of prescription opioids, sedatives, stimulants, anti-anxiety medications, antipsychotic medications, and erectile dysfunction medications. Respondents were largely male (91%), aged 40 or older (61%), identified as gay or bisexual (79%), and were men who have sex with men (MSM, 85%). ART use was nearly universal (95%). Nearly half (43%) of participants overall reported medical use of prescription opioids in the last year; 11% of the opioid use was reported as non-medical use. Anti-anxiety medication use in the last year was also frequent, and differed by site: in the last year, 41% of community clinic responders reported medical use of anti-anxiety medications compared to 23% of hospital clinic respondents who reported medical use. Prescription sedative use in the last year was also approximately twice as high among community-clinic participants, with medical use reported by 43% of respondents and non-medical use by 12%; in comparison, at the hospital clinic, sedative use was reported by 18% (medical) and 7% (non-medical) of participants in the last year. Stimulant use was rare in both sites. No demographic characteristic was significantly associated with medical or non-medical use of any prescription medication. The current focus of many studies on only non-medical prescription medication use not only underestimates the widespread exposure of HIV-positive individuals to these drugs, but may also underestimate potential adverse effects of prescription medications in this population.

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“…Others have also suggested the benefits of psychological approaches to pain management in individuals with HIV (Merlin et al, 2014). Evidence suggests that exercise produces psychological benefits such as reduced depressive symptoms (O’Brien, Nixon, Tynan, & Glazier, 2010).…”

Section: Discussionmentioning

confidence: 99%

Attitudes towards exercise among substance using older adults living with HIV and chronic pain

et al. 2017

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Chronic pain and substance use disorders occur commonly among HIV-infected persons. Recent CDC guidelines recommend non-pharmacologic approaches over opioid medications for the management of chronic pain. This is particularly relevant for persons with substance use disorders. Structured physical activity may be an effective strategy for pain reduction. We developed a combined cognitive-behavioral therapy (CBT) + exercise intervention to reduce pain, pain-related disability and substance use and improve physical function in older HIV-infected adults with chronic pain and substance use. We employed established CBT protocols for the intervention, and sought feedback from potential end users when developing the exercise component of the intervention. A total of 27 HIV-infected adults ≥50 years of age participated in four focus group sessions. Transcripts were analyzed using thematic analysis. Participant demographics: mean age 54 years; male 81%; Hispanic 48%, Black 33%; treated for substance abuse in the past 52%. Exercise was seen as a desirable activity, but many participants expressed barriers to exercise including fear of pain exacerbation, low physical fitness, and lack of availability of perceived safe spaces for HIV-infected persons. Most participants were receptive to exercise for pain reduction, particularly modalities that provide added psychological benefits of reducing stress and anxiety. Exercise for pain management among older HIV-infected adults with chronic pain and substance use was found to be highly acceptable. However, interventions need to be tailored to the unique needs of this population to address their fears and concerns.

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‘Two Pains Together’: Patient Perspectives on Psychological Aspects of Chronic Pain while Living with HIV

Cited by 24 publications

References 40 publications

A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders

A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders

High levels of self-reported prescription opioid use by HIV-positive individuals

Attitudes towards exercise among substance using older adults living with HIV and chronic pain

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