Underestimation and undertreatment of pain in HIV disease: multicentre study

Larue, François; Fontaine, A.; Colleau, Sophie M.

doi:10.1136/bmj.314.7073.23

Cited by 174 publications

(118 citation statements)

References 22 publications

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“…Our findings are limited to the U.S. population of persons in care for HIV. In contrast to a U.S. study which found that HIV+ IDUs were more likely than non-IDUs to receive inadequate analgesia for pain (Breitbart et al 1996b), a study conducted in France found that IDUs with HIV (as well as MSM and sicker patients) were actually more likely to receive some type of analgesic than other patients (Larue et al 1997), suggesting local regulatory climate may affect treatment. Undertreatment of pain among IDUs in the U.S. may relate to fear of criminal prosecution or concern regarding drug-seeking behavior.…”

Section: Discussionmentioning

confidence: 55%

Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV

Tsao

Dobalian

Stein

2005

Pain

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We investigated predictive and concurrent relationships among reported pain, HIV/AIDS illness burden, and substance use history in 2,267 participants in the longitudinal HIV Cost and Services Utilization Study (HCSUS). Substance use history was classified as screening positive for current illicit drug use (N = 253), past drug use (N = 617), and non-user (N = 1397) at baseline. To control for demographic correlates, age, sex and socioeconomic status (SES) were included as predictors. Covariance structure models indicated greater pain at baseline among participants acknowledging current substance use. Pain at baseline was also directly predicted by greater HIV/AIDS illness burden, lower SES, and older age. At 6 months, pain was directly predicted by prior pain, worse concurrent HIV/AIDS illness burden and female sex. At 12 months, pain was predicted by older age, prior pain, and concurrent HIV/AIDS illness. It was also modestly but significantly predicted by current substance use at baseline. In addition to the direct effects on pain, there were significant indirect effects of demographic and drug use variables on pain mediated through HIV/AIDS illness burden and prior pain. There were significant and positive indirect effects of current and past drug use, greater age, and lower SES on pain at all three time periods. Pain at 6 months and pain at 12 months were also indirectly impacted by previous illness burden. Our results indicate that HIV+ persons who screened positive for current use of a range of illicit substances experienced greater HIV/AIDS illness burden which in turn predicted increased pain.

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Section: Discussionmentioning

confidence: 55%

Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV

Tsao

Dobalian

Stein

2005

Pain

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“…One interpretation is that nonproblem users take opioids in a manner more consistent with and appropriate to their level of pain than those with a problem drug history who may use opioids more indiscriminately. Numerous studies have reported substantial undertreatment of pain in substance-abusing HIV + patients (e.g., Larue et al, 1997). Breitbart and colleagues (1996b) found that 84% of HIV + patients received inadequate analgesia, and Passik et al (2006) more recently reported that 32.9% of HIV+ patients compared to only 8% of cancer patients received inadequate analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…Although analogous investigations have not been conducted in HIV samples, it is likely that HIV patients with a problem drug use history would similarly evidence greater misuse of opiates than their non-problem-drug-using counterparts. There is evidence of substantial undertreatment of pain in HIV+ patients (Rosenfeld et al 1996), particularly among those with a history of substance abuse (Breitbart et al 1996b;Breitbart et al 1997;Larue et al 1997). It is possible that undertreatment of pain in this population may lead to drug seeking behaviors.…”

Section: Introductionmentioning

confidence: 99%

Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

Tsao

Stein²,

Dobalian

2007

Pain

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Little is known about the relationship between pain and aberrant use of prescription analgesics in persons living with HIV. We examined the predictive and concurrent associations among pain, aberrant use of opioids, and problem drug use history in a nationally representative longitudinal sample of 2267 HIV+ persons. Covariance structure analyses tested a conceptual model wherein HIV + patients with a history of problematic drug use (n = 870), compared to those without such history (n = 1397), were hypothesized to report more pain and aberrant opioid use, as well as use of opioids specifically for pain at baseline and 6 and 12 month follow-ups, after controlling for key sociodemographic characteristics. In support of the hypothesized model, patients with a history of problematic drug use reported more pain, and were more likely to report aberrant use of prescription analgesics, as well as use of such medications specifically for pain, compared to patients without such history. We also found a trend toward greater stability of aberrant opioid use over time in problem drug users compared with non-problem users suggesting a persistent pattern of inappropriate medication use in the former group. Our findings suggest that even though HIV+ persons with a history of problematic drug use report on-going patterns of using prescription analgesics specifically for pain, these patients continued to experience persistently higher levels of pain, relative to nonproblem users. Among non-problem users, pain was not linked to aberrant use of opioids, but was linked to the use of such medications specifically for pain.

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“…14 A similar finding was found in a multi-centre study conducted in France in 1997, where it was recorded that pain severity significantly decreased patients' quality of life. 15 A study conducted in South Africa in 2009 has shown that pain is one of the specific impairments that affect physical, psychological and social functioning in the HIV-infected individual's life. 10 These studies have also demonstrated that pain in these patients was not adequately treated.…”

Section: Introductionmentioning

confidence: 99%

Adequacy of pain management in HIV-positive patients

Narasimooloo

Naidoo

Gaede

2011

South African Family Practice

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S Afr Fam Pract 2011;53(1):71-76Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence, severity, recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods:The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive, consenting HIVpositive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain, pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life.Results: Ninety-one per cent of participants reported pain with 83% experiencing significant pain, in other words a "worst pain" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71% of the patients' medical charts that were reviewed; however, only 34% were considered to be adequately managed for their pain. Conclusion:Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records, the management of pain was considered to be inadequate in a third of those experiencing pain.Peer reviewed.

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Underestimation and undertreatment of pain in HIV disease: multicentre study

Abstract: Objective: To investigate if the incidence of disorders of spermatogenesis and testicular tissue morphology have changed in middle aged Finnish men over 10 years. Design: Two necropsy series completed in 1981 and in 1991. Setting:

Cited by 174 publications

References 22 publications

Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV

Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV

Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

Adequacy of pain management in HIV-positive patients

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