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Risk Factors and Symptoms Associated With Pain in HIV-Infected Adults

https://doi.org/10.1016/j.jana.2009.10.003Get rights and content

Studies suggest that people living with HIV (PLWH) experience many unrelieved symptoms. The purpose of this study was to estimate the occurrence of pain in adult PLWH and to determine whether participants with pain differed from those without pain on selected demographic factors, clinical characteristics, symptoms of fatigue, sleep disturbance, anxiety, or depression. The authors conducted a descriptive, comparative, and correlational study of 317 PLWH seen at academic and community clinics in San Francisco. Participants completed a demographic questionnaire, the Memorial Symptom Assessment Scale, the Fatigue Severity Scale, the General Sleep Disturbance Scale, the Profile of Moods State Tension-Anxiety subscale, and the Center for Epidemiological Studies-Depression Scale. Clinical characteristics (i.e., disease and treatment information) were obtained by self-report. A single item on pain from the Memorial Symptom Assessment Scale was used to classify participants into those with and without pain. Pain was highly prevalent (55%) and was associated with immune status (CD4+ T-cell count), race, and sleep disturbance, but not with age, gender, or symptoms of fatigue, depression, or anxiety.

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Methods

The Symptom and Genetic Study is an ongoing prospective, longitudinal study designed to identify biomarkers of the symptom experience of HIV-infected adults. This analysis evaluated data from the initial assessment of adults living with HIV in the San Francisco area. The protocol was approved by the Committee on Human Research at the University of California, San Francisco. All participants provided written informed consent before enrollment and signed a Health Insurance Portability and

Sample Characteristics

A convenience sample of 350 adults with HIV was enrolled in this study over a 3-year period (April 2005 to December 2007). Three had incomplete symptom data, 29 were excluded after screening positive for illicit drug use (i.e., cocaine, amphetamine, ecstasy, methamphetamine, or phencyclidine), and one was excluded after being unable to submit a urine sample for screening. The sample was ethnically diverse and predominantly male, which reflected the local population of adult PLWH. More than half

Discussion

This study is the first to evaluate the occurrence of pain and differences in the severity of four common symptoms in the same sample of community-based PLWH, with and without pain. Pain was reported by more than 55% of the sample, which is comparable to previous reports in PLWH but higher than the prevalence of chronic pain in the general population (Rustoen et al., 2004). In addition, regardless of pain group membership, the mean severity scores for sleep disturbance, anxiety, and depressive

Disclosures

This research was supported by a grant from the National Institute of Mental Health (NIMH, 5 R01 MH074358). Data collection was supported by the General Clinical Research Center in the University of California San Francisco Clinical and Translational Science Awards (1 UL RR024131). Dr. Aouizerat is supported by an NIH Roadmap K12 (KL2 RR024130); Dr. Davis is supported by an National Institutes of Health Research Infrastructure in Minority Institutions (RIMI) award (5P20 MD0005444).

Clinical

Acknowledgments

The authors acknowledge the contributions to the study from Ryan Kelly, Yeonsu Song, Kristen Nelson, and Matthew Shullick.

Bradley E. Aouizerat, MAS, PhD, is associate professor, Department of Physiological Nursing and Institute for Human Genetics, University of California, San Francisco.

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    Bradley E. Aouizerat, MAS, PhD, is associate professor, Department of Physiological Nursing and Institute for Human Genetics, University of California, San Francisco.

    Christine A. Miaskowski, PhD, RN, FAAN, is professor, Department of Physiological Nursing, University of California, San Francisco.

    Caryl Gay, PhD, is project director, Department of Family Health Care Nursing, University of California, San Francisco.

    Carmen J. Portillo, PhD, RN, FAAN, is professor, Community Health Systems, University of California, San Francisco.

    Traci Coggins, BS, RPSGT, is research associate, Department of Family Health Care Nursing, University of California, San Francisco.

    Harvey Davis, PhD, RN, is assistant professor, School of Nursing, San Francisco State University, San Francisco.

    Clive R. Pullinger, PhD, is associate professor, Department of Physiological Nursing and Cardiovascular Research Institute, University of California, San Francisco.

    Kathryn A. Lee, PhD, RN, FAAN, is professor, Department of Family Health Care Nursing, University of California, San Francisco.

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