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Pain Among Ambulatory HIV/AIDS Patients: Multicenter Study of Prevalence, Intensity, Associated Factors, and Effect

      Abstract

      This study aimed to determine the prevalence, intensity, associated factors, and effect of pain among ambulatory HIV/AIDS patients. Three-hundred two adult ambulatory HIV/AIDS patients were consecutively recruited from HIV/AIDS outpatient clinics at 2 teaching hospitals in Uganda. The presence and intensity of pain were self-reported using the Brief Pain Inventory (BPI); symptom data were collected using the Memorial Symptom Assessment Scale (MSAS-SF); and quality of life (QOL) was assessed using the Medical Outcome Scale-HIV. Forty-seven percent reported pain in the 7 days prior to the survey and pain was a symptom at the time of diagnosis for 68%. On the 0 to 10 numeric scale, 53% reported mild pain (1–4 rating), 20% reported moderate pain (5–6 rating) while 27% reported severe pain (7–10 rating). Gender was not associated with pain intensity, but reduced functional performance, increasing number of symptoms, advanced HIV disease , physical symptom distress (MSAS-SF), and number of health comorbidities were significantly associated with pain intensity (P < .04). Increasing pain intensity was associated with greater functional ability impairment (BPI functional interference index) and poorer QOL. Pain is a common symptom among ambulatory HIV/AIDS patients and has a debilitating effect on QOL. There is a significant unmet need for pain relief in the population.

      Perspective

      This article discusses the characteristics and effect of pain on function and QOL in East African patients. It also contributes information on characteristics of HIV/AIDS adult patients in the East Africa demonstrating the aspects in which pain is similar across different cultures.

      Key words

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      References

        • Altman D.G.
        Practical Statistics for Medical Research.
        Chapman and Hall/CRC, London, UK1990
        • Aouizerat B.E.
        • Miaskowski C.A.
        • Gay C.
        • Portillo C.J.
        • Coggins T.
        • Davis H.
        • Pullinger C.R.
        • Lee K.A.
        Risk factors and symptoms associated with pain in HIV-infected adults.
        J Assoc Nurses AIDS Care. 2010; 21: 125-133
        • Bernard N.
        • Spira R.
        • Ybanez S.
        • Chene 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: 293-295
        • Breitbart W.
        • Passik S.
        • McDonald M.V.
        • Rosenfeld B.
        • Smith M.
        • Kaim M.
        • Funesti-Esch J.
        Patient-related barriers to pain management in ambulatory AIDS patients.
        Pain. 1998; 76: 9-16
        • Breitbart W.
        • McDonald M.V.
        • Rosenfeld B.
        • Passik S.D.
        • Hewitt D.
        • Thaler H.T.
        • Portenoy R.K.
        Pain in ambulatory AIDS patients. I: Pain characteristics and medical correlates.
        Pain. 1996; 68: 315-321
        • Breitbart W.
        Psychiatric aspects of pain and HIV disease.
        Focus. 1990; 5: 1-3
      1. Centre for Disease Control and Prevention. 1993. Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Atlanta, Georgia, USA: MMWR, December 18 1992; 41:6 (RR-17):6. Available at: www.cdc.gov/mmrw. Accessed April 21, 2011

        • Cervia L.D.
        • McGowan J.P.
        • Weseley A.J.
        Clinical and demographic variables related to pain in HIV-infected individuals treated with effective, combination antiretroviral therapy (cART).
        Pain Med. 2010; 11: 498-503
        • Chang V.T.
        • Hwang S.S.
        • Thaler H.T.
        • Kasismis B.S.
        • Portenoy R.K.
        Memorial symptoms assessment scale.
        Expert Rev Pharmacoecon Outcomes Res. 2004; 4: 171-178
        • Cleeland C.S.
        Symptom burden: Multiple symptoms and their impact as patient-reported outcomes.
        J Natl Cancer Inst Monogr. 2007; 37: 16-21
        • Cleeland C.S.
        Pain control: public and physicians’ attitudes.
        in: Advances in Pain Research and Therapy. Vol 11. Raven press, New York, NY1989: 81-89
        • Cleeland C.S.
        • Gonin R.
        • Hatfield A.K.
        • Edmonson J.H.
        • Blum R.H.
        • Stewart J.A.
        • Pandya J.K.
        Pain and its treatment in outpatients with metastatic cancer.
        N Engl J Med. 1996; 330: 592-596
        • Cleeland C.S.
        • Nakamura Y.
        • Mendoza T.R.
        • Edwards K.R.
        • Douglas J.
        • Serlin R.C.
        Dimensions of the impact of cancer pain in a four country sample: New information from multidimensional scaling.
        Pain. 1996; 67: 267-273
        • Cleeland C.S.
        • Portenoy R.K.
        • Rue M.
        • Mendoza T.R.
        • Weller E.
        • Payne R.
        • Kirshner J.
        • Atkins J.N.
        • Johnson P.A.
        • Marcus A.
        Does an oral analgesic protocol improve pain control for patients with cancer? An intergroup study coordinated by the Eastern Cooperative Oncology Group.
        Ann Oncol. 2005; 16: 972-980
        • Cleeland C.S.
        • Ryan K.M.
        Pain Assessment: Global Use of the Brief Pain Inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Collins K.
        • Harding R.
        Improving HIV management in sub-Saharan Africa: How much palliative care is needed?.
        AIDS Care. 2007; 19: 1304-1306
        • Del Borgo C.
        • Izzi I.
        • Chiarotti F.
        • Del Forno A.
        • Moscati A.M.
        • Cornacchione E.
        • Fantoni M.
        Multidimensional aspect of pain in HIV infected individuals.
        AIDS Patient Care STDs. 2001; 15: 95-102
        • Dobalian A.
        • Tsao J.C.
        • Duncan R.P.
        Pain and the use of outpatient services among persons with HIV: Results from a nationally representative survey.
        Med Care. 2004; 42: 129-138
        • George K.
        Research design in end-of-life research: State of science.
        Gerontologist. 2002; 42: 86-98
        • Gray G.
        • Berger P.
        Pain in women with HIV/AIDS.
        Pain. 2007; 132: S13-S21
        • Harding R.
        • Molloy T.
        • Easterbrook P.
        • Frame K.
        • Higginson I.J.
        Is antiretroviral therapy associated with symptom prevalence and burden?.
        Int J STD AIDS. 2006; 17: 400-405
        • Harding R.
        • Powell R.A.
        • Kiyange F.
        • Downing J.
        • Mwangi-Powell F.
        Provision of pain- and symptom-relieving drugs for HIV/AIDS in Sub-Saharan Africa.
        J Pain Symptom Manage. 2010; 40: 405-415
        • Hardon A.P.
        • Akurut D.
        • Comoro C.
        • Ekezie C.
        • Irunde H.F.
        • Gerrits T.
        • Kglatwane J.
        • Kinsman J.
        • Kwasa R.
        • Maridadi J.
        • Moroka T.M.
        • Moyo S.
        • Nakiyemba A.
        • Nsimba S.
        • Ogenyi R.
        • Oyabba T.
        • Temu F.
        • Laing R.
        Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa.
        AIDS Care. 2007; 19: 658-665
        • Heckman T.G.
        • Somlai A.M.
        • Peters J.
        • Walker J.
        • Otto-Salaj L.
        • Galdabini C.A.
        • Kelly J.A.
        Barriers to care among persons living with HIV/AIDS in urban and rural areas.
        AIDS Care. 1998; 10: 365-375
        • Hewitt D.J.
        • McDonald M.
        • Portenoy R.K.
        • Rosenfeld B.
        • Passik S.
        • Breitbart W.
        Pain syndromes and aetiologies in ambulatory AIDS patients.
        Pain. 1997; 70: 117-123
        • Holzemer W.L.
        • Hudson A.
        • Kirksey K.M.
        • Hamilton M.J.
        • Bakken S.
        The Revised Sign and Symptom Check-List for HIV (SSC-HIV rev).
        J Assoc Nurses AIDS Care. 2001; 61: 60-70
        • Hughes A.
        Symptom management in HIV- infected patients.
        J Assoc Nurses AIDS Care. 2004; 15: 7s-13s
        • Hulley S.B.
        • Cummings S.R.
        • Browner W.S.
        • Grady D.
        • Hearst N.
        • Newman T.B.
        Designing Clinical Research.
        Lippincott Williams and Wilkins, New York, NY2007 (pp 30-45)
        • Jackson T.
        • Lezzi T.
        • Gunderson J.
        • Nagaska T.
        • Jackson A.F.
        Gender differences in pain perception: The mediating role of self efficacy.
        Sex Roles. 2002; 47: 561-568
        • Jelsma J.
        • Maclean E.
        • Hughes J.
        • Tinise X.
        • Darder M.
        An investigation into the health-related quality of life of individuals living with HIV who are receiving HAART.
        AIDS Care. 2005; 17: 579-588
        • Karnofsky D.A.
        • Burchenal J.H.
        The clinical evaluation of chemotherapeutic agents in cancer.
        in: Macleod C.M. Evaluation of Chemotherapeutic Agents. Columbia University Press, New York, NY1949: 199-205
        • Katwere M.
        • Kambugu A.
        • Piloya T.
        • Wong M.
        • Hendle-Paterson B.
        • Sande M.A.
        • Ronald A.
        • Katabira E.
        • Menten J.
        • Colebunders R.
        Clinical presentation and aetiologies of acute or complicated headache among HIV sero-positive patients in a Ugandan clinic.
        J Int AIDS Soc. 2009; 12: 1-8
        • Kish L.
        Survey sampling.
        John Wiley and Sons, New York, NY1965
        • Koffman J.
        • Morgan M.
        • Higginson I.J.
        Cultural meaning of pain: A qualitative study of Black Caribbean and White British patients with advanced cancer.
        Palliat Med. 2008; 224: 350-359
        • Larue F.
        • Fontaine A.
        • Colleau S.N.
        Underestimation and under treatment of pain in HIV disease: Multicenter study.
        Br Med J. 1997; 314: 223-228
        • Lebovits A.H.
        • Lefkowitz M.
        • McCarth D.
        • Simon R.
        • Wilpon H.
        • Jung R.
        • Fried E.
        The prevalence and management of pain in AIDS: A review of 134 cases.
        Clin J Pain. 1989; 5: 245-248
        • Mast T.C.
        • Kigozi G.
        • Wabwire-Mangen F.
        • Black R.
        • Sewankambo N.
        • Serwadda D.
        • Gray R.
        • Wawer M.
        • Wu A.W.
        Measuring quality of life among HIV- infected women using a culturally adapted questionnaire in Rakai district, Uganda.
        AIDS Care. 2004; 216: 81-94
        • Mathews W.C.
        • McCutchan J.A.
        • Asch S.
        • Turner B.J.
        • Gifford A.L.
        • Kuromiya K.
        • Brown J.
        • Shapiro M.F.
        • Bozzette S.A.
        National estimates of HIV-related symptom prevalence from the HIV Cost and Services Utilization Study.
        Med Care. 2000; 38: 750-762
        • McComarck J.
        • Li R.
        • Zarowny D.
        • Singer J.
        Inadequate treatment of pain in ambulatory HIV patients.
        Clin J Pain. 1993; 9: 279-283
        • McDowell I.
        • Jenkinson C.
        Developing standards for health measures.
        J Health Serv Res Policy. 1996; 4: 238-246
        • Mphahlele N.
        • Mitchell D.
        • Kamerman P.
        Validation of the Wisconsin Brief Pain Questionnaire in a multilingual South African population.
        J Pain Symptom Manage. 2008; 36: 396-412
        • Namisango E.
        • Katabira E.
        • Karamagi C.
        • Baguma P.
        Validation of the Missoula-Vitas Quality-of-Life Index among patients with advanced AIDS in urban Kampala, Uganda.
        J Pain Symptom Manage. 2007; 33: 189-202
        • Norval D.A.
        Symptoms and sites of pain experienced by AIDS patients.
        S Afr Med. 2004; 94: 450-454
        • O’Keefe E.A.
        • Wood R.
        The impact of human immunodeficiency virus (HIV) infection on quality of life in a multiracial South African population.
        Qual Life Res. 1996; 5: 275-280
        • Peltzer K.
        • Phaswana-Mafuya N.
        The symptom experience of people living with HIV and AIDS in the Eastern Cape, South Africa.
        BMC Health Serv Res. 2008; 8: 271
        • Portenoy R.K.
        • Thaler H.T.
        • Kornblith A.B.
        • Lepore J.M.
        • Friedlander-Klar H.
        • Kiyasu E.
        • Sobel K.
        • Coyle N.
        • Kemeny N.
        • Norton L.
        • Scher H.
        The Memorial Symptom Assessment Scale: An instrument for the evaluation of symptom prevalence, characteristics and distress.
        Eur J Cancer. 1994; 30A: 1326-1336
        • Portenoy R.K.
        • Miransky J.
        • Thaler H.T.
        • Hornung J.
        • Bianchi C.
        • Cibas-Kong I.
        • Feldhamer E.
        • Lewis F.
        • Matamoros I.
        • Sugar M.Z.
        • Oliveri P.A.
        • Kemny N.E.
        • Foley K.M.
        Pain in ambulatory patients with lung or colon cancer.
        Cancer. 1991; 70: 1616-1624
        • Powers K.A.
        • Miller W.C.
        • Pilcher C.D.
        • Mapanje C.
        • Martinson F.E.
        • Fiscus S.A.
        • Chilongozi D.A.
        • Namakhwa D.
        • Price M.A.
        • Galvin S.R.
        • Hoffman I.F.
        • Cohen M.S.
        Improved detection of acute HIV-1 infection in sub-Saharan Africa: Development of a risk score algorithm.
        AIDS. 2007; 21: 2237-2242
        • Revicki D.A.
        • Sorensen S.
        • Wu A.W.
        Reliability and validity of physical and mental health summary scores from the Medical Outcomes Study HIV Health Survey.
        Med Care. 1998; 36: 126-137
        • Rosenfeld B.
        • Breitbart W.
        • McDonald M.V.
        • Passik S.D.
        • Thaller H.T.
        • Portenoy R.K.
        Pain in ambulatory AIDS patients. II: Impact of pain on psychological functioning and quality of life.
        Pain. 1996; 68: 323-328
        • Rustoen T.
        • Wahl A.K.
        • Hanestad B.R.
        • Lerdal A.
        • Paul S.
        • Miaskowski C.
        Prevalence and characteristics of chronic pain in the general Norwegian population.
        Eur J Pain. 2004; 8: 555-565
        • Schofferman J.
        Pain: Diagnosis and management in the palliative care of AIDS.
        J Palliat Care. 1988; 14: 46-49
        • Selwyn P.A.
        • Rivard M.
        • Kapell D.
        • Goeren B.
        • LaFosse H.
        • Schwartz C.
        • Luciano D.
        Palliative care for AIDS at a large urban teaching hospital: Program description and preliminary outcomes.
        Palliat Med. 2003; 6: 461-474
        • Serlin R.C.
        • Mendoza T.R.
        • Nakamura Y.
        • Edwards K.R.
        • Cleeland C.S.
        When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function.
        Pain. 1995; 61: 277-284
        • Singer E.J.
        • Zorilla C.
        • Fahy-Chandon B.
        • Chi S.
        • Syndulko K.
        • Tourtellote W.W.
        Painful symptoms reported by ambulatory HIV-infected men in a longitudinal study.
        Pain. 1993; 54: 15-19
        • Skevington S.
        Investigating the relationship between pain and discomfort and quality of life, using the WHOQOL.
        Pain. 1998; 76: 395-406
        • Solano J.P.
        • Gomes B.
        • Higginson I.J.
        A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease.
        J Pain Symptom Manage. 2006; 31: 58-69
        • Stangl A.L.
        • Wamai J.
        • Mermin A.C.
        • Awor C.
        • Bunnel R.E.
        Trends and predictors of quality of life among HIV-infected adults taking highly active antiretroviral therapy in rural Uganda.
        AIDS Care. 2007; 19: 626-636
        • Tabachnick B.G.
        • Fidell L.S.
        Using multivariate statistics.
        Harper Collins, New York, NY1996
        • Tsao J.C.I.
        • Dobalian A.
        • Naliboff B.D.
        Panic disorder and pain in a national survey of persons living with HIV.
        Pain. 2004; 109: 172-180
      2. UNAIDS Report on the Global AIDS Epidemic 2010: Joint United Nations Program on HIV/AIDS. Geneva, Switzerland. Available at http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2010/20101123_globalreport_en.pdf. Accessed September 21, 2011

        • Van A.S.
        • Myezwa H.
        • Stewart A.
        • Maleka D.
        • Musenge E.
        The International Classification of Function Disability and Health (ICF) in adults visiting the HIV outpatient clinic at a regional hospital in Johannesburg, South Africa.
        AIDS Care. 2009; 21: 50-58
        • Vogl D.
        • Rosenfeld B.
        • Breitbart W.
        • Passik S.
        • McDonald M.
        • Portenoy R.K.
        Symptom prevalence characteristics and distress in AIDS outpatients.
        J Pain Symptom Manage. 1999; 18: 253-261
        • Von Korff M.
        Perspectives on the management of back pain in primary care.
        in: Proceedings on the VIIth World Congress in Pain: Progress in Pain Research Management. Vol. 2. IASP Press, Seattle, WA1994: 97-112
        • Voss J.G.
        • Sukati N.A.
        • Seboni N.M.
        • Makoae L.N.
        • Moleko M.
        • Human S.
        • Molosiwa K.
        • Holzemer W.L.
        Symptom burden of fatigue in men and women living with HIV/AIDS in Southern Africa.
        J Assoc Nurses AIDS Care. 2007; 18: 22-31
        • Wakeham K.
        • Harding R.
        • Bamukama-Namakoola D.
        • Levin J.
        • Kissa J.
        • Parkes-Ratanshi R.
        • Muzaaya G.
        • Grosskurth H.
        • Lallo D.G.
        Symptom burden in HIV-infected adults at the time of HIV diagnosis in rural Uganda.
        Palliat Med. 2010; 13: 375-380
        • Willard S.
        • Holzemer W.L.
        • Wantland D.J.
        • Cuca Y.P.
        • Kirksey K.M.
        • Portillo C.J.
        • Corless I.B.
        • Rivero-Méndez M.
        • Rosa M.E.
        • Nicholas P.K.
        • Hamilton M.J.
        • Sefcik E.
        • Kemppainen J.
        • Canaval G.
        • Robinson L.
        • Moezzi S.
        • Human S.
        • Arudo J.
        • Eller L.S.
        • Bunch E.
        • Dole P.J.
        • Coleman C.
        • Nokes K.
        • Reynolds N.R.
        • Tsai Y.F.
        • Maryland M.
        • Voss J.
        • Lindgren T.
        Does “asymptomatic” mean without symptoms for those living with HIV infection?.
        AIDS Care. 2009; 21: 322-328
      3. World Health Organization. WHO Case Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological Classification of HIV-Related Disease In Adults and Children. 2007. Available at: www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf. Accessed June 6, 2011

      4. World Health Organization, Cancer Pain Relief and Palliative Care, WHO Technical Report Series 804, Geneva, 1990

        • Wu A.W.
        • Hays R.
        • Kelly S.
        • Malitz F.
        • Bozette S.A.
        Applications of the Medical Outcomes Scale Study health-related quality of life measures in HIV/AIDS.
        Qual Life Res. 1997; 6: 531-554