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AIDS and Behavior

, Volume 22, Issue 6, pp 2008–2017 | Cite as

Frequent Occurrence of Pain and Prescription Opioid Use for Treatment of Pain Among Women with and at Risk for HIV Infection

  • Anjali Sharma
  • Donald R. Hoover
  • Qiuhu Shi
  • Jennie C. I. Tsao
  • Christopher Cox
  • Deborah R. Gustafson
  • Kathleen Weber
  • Ruth M. Greenblatt
  • Bradley E. Aouizerat
  • Michael W. Plankey
Original Paper

Abstract

Pain is frequent and underreported among HIV+ women. We determined occurrence and severity of pain, and types of pain treatments used among HIV+ and HIV− women. Cross-sectional analyses of pain as measured by the Brief Pain Inventory Short Form, and related pain therapies nested in the Women’s Interagency HIV Study (WIHS). Multiple variable linear regression models examined differences by HIV status in pain severity and pain interference in general activity, mood, ability to walk, work, relationships with others, sleep, and enjoyment of life. Among 1393 HIV+ and 587 HIV− participants with median age 47–48 years, there was no statistically significant difference in pain reported within the past week by HIV status (HIV+ 50% vs. 49% HIV−, p = 0.70). Ratings of pain severity and interference were similar between HIV+ and HIV− women, as was receipt of pain medication (58% HIV+ vs. 56% HIV−). Pain medications most frequently used were: NSAIDS (90% HIV+, 96% HIV−), opioids (65% HIV+, 67% HIV−), topical anesthetics (46% HIV+, 56% HIV−), muscle relaxants (23% HIV+, 14% HIV−), and anticonvulsants (23% HIV+, 14% HIV−). Nearly half of predominantly low income, minority women reported pain in the past week, and two-thirds reported opioid use for pain management. The occurrence, severity, and treatment of pain did not differ by HIV status, nor did report of pain interference with mood or function. Additional research is needed to better characterize pain etiology among HIV+ women in the era of potent antiretroviral therapy, and determine the extent to which pain severity and type of medication used for pain treatment impact HIV disease outcomes.

Keywords

Pain HIV Women Opioid 

Notes

Funding

The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA). WIHS (Principal Investigators): UAB-MS WIHS (Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Alexandra Levine and Marek Nowicki), U01-HD-032632 (WIHS I – WIHS IV). This research was also supported by National Institutes of Health K23AR06199301 (AS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH).

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Breitbart W, McDonald MV, Rosenfeld B, et al. Pain in ambulatory AIDS patients. I: pain characteristics and medical correlates. Pain. 1996;68:315–21.CrossRefPubMedGoogle Scholar
  2. 2.
    Singer EJ, Zorilla C, Fahy-Chandon B, et al. Painful symptoms reported by ambulatory HIV-infected men in a longitudinal study. Pain. 1993;54:15–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Hewitt DJ, McDonald M, Portenoy RK, et al. Pain syndromes and etiologies in ambulatory AIDS patients. Pain. 1997;70:117–23.CrossRefPubMedGoogle Scholar
  4. 4.
    Vogl D, Rosenfeld B, Breitbart W, et al. Symptom prevalence, characteristics, and distress in AIDS outpatients. J Pain Symptom Manage. 1999;18:253–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Frich LM, Borgbjerg FM. Pain and pain treatment in AIDS patients: a longitudinal study. J Pain Symptom Manage. 2000;19:339–47.CrossRefPubMedGoogle Scholar
  6. 6.
    Merlin JS, Cen L, Praestgaard A, Turner M, Obando A, Alpert C, Woolston S, Casarett D, Kostman J, Gross R, Frank I. Pain and physical and psychological symptoms in ambulatory HIV patients in the current treatment era. J Pain Symptom Manage. 2012;43(3):638–45.CrossRefPubMedGoogle Scholar
  7. 7.
    National Centers for Health Statistics. Chartbook on Trends in the Health of Americans 2006, Special Feature: Pain. http://www.cdc.gov/nchs/data/hus/hus06.pdf.
  8. 8.
    Dobalian A, Tsao JC, Duncan RP. Pain and the use of outpatient services among persons with HIV: results from a nationally representative survey. Med Care. 2004;42(2):129–38.CrossRefPubMedGoogle Scholar
  9. 9.
    Aouizerat BE, Miasakowski CA, Gay C, Portillo CJ, et al. Risk factors and symptoms associated with pain in HIV-infected adults. J Assoc Nurses AIDS Care. 2010;21(2):125–33.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Davis S. Clinical sequelae affecting quality of life in the HIV-infected patient. J Assoc Nurses AIDS Care. 2004;15(5 Suppl):28S–33S.CrossRefPubMedGoogle Scholar
  11. 11.
    Lorenz KA, Shapiro MF, Asch SM, et al. Associations of symptoms and health-related quality of life: findings from a national study of persons with HIV infection. Ann Intern Med. 2001;134:854–60.CrossRefPubMedGoogle Scholar
  12. 12.
    Merlin JS, Westfall AO, Chamot E, Overton ET, Willig JH, Ritchie C, Saag MS, Mugavero MJ. Pain is independently associated with impaired physical function in HIV-infected patients. Pain Med. 2013;14(12):1985–93.CrossRefPubMedGoogle Scholar
  13. 13.
    Rosenfeld B, Breitbart W, McDonald MV, et al. Pain in ambulatory AIDS patients. II: impact of pain on psychological functioning and quality of life. Pain. 1996;68:323–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Miaskowski C, Penko JM, Guzman D, Mattson JE, Bangsberg DR, Kushel MB. Occurrence and characteristics of chronic pain in a community-based cohort of indigent adults living with HIV infection. J Pain. 2011;12(9):1004–16.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Breitbart W, Rosenfeld BD, Passik SD, McDonald MV, Thaler H, Portenoy RK. The undertreatment of pain in ambulatory AIDS patients. Pain. 1996;65:243–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Larue F, Fontaine A, Colleau SM. Underestimation and undertreatment of pain in HIV disease: multicentre study. BMJ. 1997;314(7073):23–8.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Sullivan LW, Eagel BA. Leveling the playing field: recognizing and rectifying disparities in management of pain. Pain Med. 2005;6:5–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Tsao JC, Dobalian A, Stein JA. Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV. Pain. 2005;119:124–32.CrossRefPubMedGoogle Scholar
  19. 19.
    Vitiello B, Burnam AM, Bing EG, Beckman R, Shapiro MF. Use of psychotropic medications among HIV-infected patients in the United States. Am J Psychiatry. 2003;160:547–54.CrossRefPubMedGoogle Scholar
  20. 20.
    Tsao JCI, Dobalian A, Moreau C, Dobalian K. Stability of anxiety and depression in a national sample of adults with human immunodeficiency virus. J Nerv Ment Dis. 2004;192:111–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Tsao JCI, Dobalian A, Naliboff BD. Panic disorder and pain in a national sample of persons living with HIV. Pain. 2004;109:172–80.CrossRefPubMedGoogle Scholar
  22. 22.
    Bernard N, Spira R, Ybanez S, Chêne G, Morlat P, Lacoste D, Loury-Larivière I, Nouts C, Burucoa B, Lebras M, Beylot J. Prevalence and underestimation of pain in HIV-infected patients by physicians: a cross-sectional study in a day care hospital. AIDS. 1999;13(2):293–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Tsao JCI, Stein JA, Aram Dobalian A. Sex differences in pain and misuse of prescription analgesics among persons with HIV. Pain Med. 2010;11(6):815–24.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lebovits AH, Smith G, Maignan M, Lefkowitz M. Pain in hospitalized patients with AIDS: analgesic and psychotropic medications. Clin J Pain. 1994;10(2):156–61.CrossRefPubMedGoogle Scholar
  25. 25.
    Del Borgo C, Izzi I, Chiarotti F, Del Forno A, Moscati AM, Cornacchione E, Fantoni M. Multidimensional aspects of pain in HIV-infected individuals. AIDS Patient Care STDS. 2001;15(2):95–102.CrossRefPubMedGoogle Scholar
  26. 26.
    Leserman J, Whetten K, Lowe K, Stangl D, Swartz MS, Thielman NM. How trauma, recent stressful events, and PTSD affect functional health status and health utilization in HIV-infected patients in the south. Psychosom Med. 2005;67(3):500–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Harding R, Molloy T, Easterbrook T, et al. Is antiretroviral therapy associated with symptom prevalence and burden? Int J STD AIDS. 2006;17:400–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Newshan G, Bennett J, Holman S. Pain and other symptoms in ambulatory HIV patients in the age of highly active antiretroviral therapy. J Assoc Nurses AIDS Care. 2002;13:78–83.CrossRefPubMedGoogle Scholar
  29. 29.
    Cervia LD, McGowan JP, Weseley AJ. Clinical and demographic variables related to pain in HIV-infected individuals treated with effective, combination antiretroviral therapy (cART). Pain Med. 2010;11:498–503.CrossRefPubMedGoogle Scholar
  30. 30.
    Merlin JS, Westfall AO, Raper JL, Zinski A, Norton WE, Willig JH, Gross R, Ritchie CS, Saag MS, Mugavero MJ. Pain, mood, and substance abuse in HIV: implications for clinic visit utilization, antiretroviral therapy adherence, and virologic failure. J Acquir Immune Defic Syndr. 2012;61:164–70.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Barkan SE, Melnick SL, Preston-Martin S, Weber K, Kalish LA, Miotti P, Young M, Greenblatt R, Sacks H, Feldman J. The Women’s Interagency HIV Study. WIHS Collaborative Study Group. Epidemiology. 1998;9(2):117–25.CrossRefPubMedGoogle Scholar
  32. 32.
    Bacon MC, von Wyl V, Alden C, Sharp G, Robison E, Hessol N, Gange S, Barranday Y, Holman S, Weber K, Young MA. The Women’s Interagency HIV Study: an observational cohort brings clinical sciences to the bench. Clin Diagn Lab Immunol. 2005;12(9):1013–9.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf. Downloaded 16 Sep 2014.
  34. 34.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measur. 1977;1:385–401.CrossRefGoogle Scholar
  35. 35.
    Tien PC, Schneider MF, Cox C, Karim R, Cohen M, Sharma A, Young M, Glesby MJ. Association of HIV infection with incident diabetes mellitus: impact of using hemoglobin A1C as a criterion for diabetes. J Acquir Immune Defic Syndr. 2012;61(3):334–40.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Mendoza TR, Mayne T, Rublee D, Cleeland CS. Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis. Eur J Pain. 2006;10(4):353–61.CrossRefPubMedGoogle Scholar
  37. 37.
    Cheville AL, Sloan JA, Northfelt JA, Jillella AP, Wong GA, Bearden JD, et al. Use of a lidocaine patch in the management of postsurgical neuropathic pain in patients with cancer: a phase III double-blind crossover study (N01CB). Support Care Cancer. 2009;17(4):451–60.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Skljarevski V, Zhang S, Desaiah D, Alaka KJ, Palacios S, Miazgowski T, Patrick K. Duloxetine versus placebo in patients with chronic low back pain: a 12-week, fixed-dose, randomized, double-blind trial. J Pain. 2010;11(12):1282–90.CrossRefPubMedGoogle Scholar
  39. 39.
    Haozous EA, Knobf MT, Brant JM. Understanding the cancer pain experience in American Indians of the Northern Plains. Psychooncology. 2011;20(4):404–10.CrossRefPubMedGoogle Scholar
  40. 40.
    Kalyadina SA, Ionova TI, Ivanova MO, Uspenskaya OS, Kishtovich AV, Mendoza TR, Guo H, Novik A, Cleeland CS, Wang XS. Russian Brief Pain Inventory: validation and application in cancer pain. J Pain Symptom Manage. 2008;35(1):95–102.CrossRefPubMedGoogle Scholar
  41. 41.
  42. 42.
    Calvelli T, Denny TN, Paxton H, Gelman R, Kagan J. Guideline for flow cytometric immunophenotyping: a report from the National Institute of Allergy and Infectious Diseases. Division of AIDS. Cytometry. 1993;14(7):702–15.CrossRefPubMedGoogle Scholar
  43. 43.
    Al-Harthi L, Voris J, Du W, Wright D, Nowicki M, Frederick T, Landay A, Kovacs A. Evaluating the impact of hepatitis C virus (HCV) on highly active antiretroviral therapy-mediated immune responses in HCV/HIV-coinfected women: role of HCV on expression of primed/memory T cells. J Infect Dis. 2006;193(9):1202–10 Epub 2006 Mar 17.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Margolis AM, Heverling H, Pham PA, Stolbach A. A review of the toxicity of HIV medications. J Med Toxicol. 2014;10(1):26–39. doi: 10.1007/s13181-013-0325-8.CrossRefPubMedGoogle Scholar
  45. 45.
    Dowell D, Haegerich TM, Chou R. CDC guidelines for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65(No. RR-1):1–49. doi: 10.15585/mmwr.rr6501e1.
  46. 46.
    Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007–2012. Am J Prev Med. 2015;49:409–13.CrossRefPubMedGoogle Scholar
  47. 47.
    CDC, National Center for Health Statistics. Health, United States, 2014: with special feature on adults aged 55–64. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2015.Google Scholar
  48. 48.
    CDC. Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morb Mortal Wkly Rep. 2011;60:1487–92.Google Scholar
  49. 49.

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Anjali Sharma
    • 1
  • Donald R. Hoover
    • 2
  • Qiuhu Shi
    • 3
  • Jennie C. I. Tsao
    • 4
  • Christopher Cox
    • 5
  • Deborah R. Gustafson
    • 6
  • Kathleen Weber
    • 7
  • Ruth M. Greenblatt
    • 8
  • Bradley E. Aouizerat
    • 9
  • Michael W. Plankey
    • 10
  1. 1.Department of MedicineAlbert Einstein College of MedicineBronxUSA
  2. 2.Department of StatisticsRutgers UniversityPiscatawayUSA
  3. 3.Department of Epidemiology and Community HealthNew York Medical CollegeValhallaUSA
  4. 4.Department of Pediatrics, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesUSA
  5. 5.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  6. 6.Department of NeurologyState University of New York Downstate Medical CenterBrooklynUSA
  7. 7.Department of MedicineJohn H. Stroger Jr. Hospital of Cook County/Hektoen Institute of MedicineChicagoUSA
  8. 8.Department of Clinical PharmacyUniversity of California San Francisco School of PharmacySan FranciscoUSA
  9. 9.Department of Oral and Maxillofacial SurgeryNew York University College of DentistryNew YorkUSA
  10. 10.Department of MedicineGeorgetown University Medical CenterWashingtonUSA

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