Occurrence and characteristics of chronic pain in a community-based cohort of indigent adults living with HIV infection

Abstract

Pain is common among people living with HIV/AIDS (PLWHA), but little is known about chronic pain in socioeconomically disadvantaged HIV-infected populations with high rates of substance abuse in the postantiretroviral era. This cross-sectional study describes the occurrence and characteristics of pain in a community-based cohort of 296 indigent PLWHA. Participants completed questionnaires about sociodemographics, substance use, depression, and pain. Cut-point analysis was used to generate categories of pain severity. Of the 270 participants who reported pain or the use of a pain medication in the past week, 8.2% had mild pain, 38.1% had moderate pain, and 53.7% had severe pain. Female sex and less education were associated with more severe pain. Depression was more common among participants with severe pain than among those with mild pain. Increasing pain severity was associated with daily pain and with chronic pain. Over half of the participants reported having a prescription for an opioid analgesic. Findings from this study suggest that chronic pain is a significant problem in this high risk, socioeconomically disadvantaged group of patients with HIV disease and high rates of previous or concurrent use of illicit drugs.

Perspective: This article presents epidemiological data showing that unrelieved chronic pain is a significant problem for indigent people living with HIV. Participants reported pain severity similar to those with metastatic cancer. Despite high rates of substance use disorders, approximately half received prescriptions for opioid analgesics, although few for long-acting agents.

Figure 1

Pain interference item scores for the total sample and differences in pain interference item scores among the three pain severity groups are reported as means (± standard deviations). Significant differences in all of the interference items, as well as in the total interference score, were found among the three pain severity groups (all p <0.0001; mild < moderate < severe).

Figure 2

Figure 2A – SF-36 subscale scores for the total sample and differences in SF-36 subscale scores among the three pain severity groups are reported as means (± standard deviations). Significant differences in the physical functioning (PF, p<0.0001; severe < moderate < mild, all p <0.038), role physical (RP, p=0.005; severe < mild, p = 0.012), bodily pain (BP, p<0.0001; severe < moderate, < mild, all p ≤0.038), role-emotional (RE, p=0.036; no significant post-hoc contrasts) and mental health (MH, p=0.004; severe = moderate < mild, p <0.027) subscale scores were found among the pain severity groups. No differences were found among the pain severity groups in general health (GH) or vitality (V) subscale scores. Figure 2B – Mental health component summary (MCS) and physical health component summary (PCS) scores for the United States (U.S.) general population, total sample, and pain severity groups are reported as means (± standard deviations). Significant differences in PCS scores were found among the pain severity groups (p=0.005, severe < moderate < mild, p≤0.0381).