Abstract
Psychological factors including pain catastrophizing and resilience associate with adjustment and quality of life in people living with chronic pain. Nevertheless, their presentation among females living with HIV and chronic pain has been poorly studied. Given that chronic pain in those living with HIV might occur due to different mechanisms (nociceptive or neuropathic), we hypothesize that the associated psychological states could also differ between these groups. We aimed to compare pain frequency and interference, psychological factors and sleep quality between females living with chronic nociceptive or neuropathic pain. Also, we explored correlations between psychological factors, pain severity and interference in females living with HIV and chronic pain. We performed a cross sectional study assessing females living with HIV and chronic pain, and compared it with a female HIV-positive, pain-free control sample in Brazil. To discriminate the most likely underlying mechanism for the chronic pain, we applied the Leeds Assessment for Neuropathic Signs and Symptoms (LANSS). Forty-nine females living with HIV and chronic pain were assessed, and divided in control (n = 12), nociceptive (n = 10) and neuropathic pain (n = 27) groups. Using validated scales, their pain catastrophizing, resilience, depression, anxiety and sleep disorders were assessed between May 2014 and August 2015. Compared to controls, females living with HIV and neuropathic chronic pain had higher pain frequency (p<0.001), interference on activities (p = 0.002), interference with emotions (p<0.001), catastrophizing (p<0.001), depression (p = 0.015), and lower resilience (p = 0.011). Catastrophizing was also significantly correlated to the burden of chronic pain. The type of chronic pain in females living with HIV should raise concerns regarding significant burden in psychological states in this population (particularly neuropathic pain). Using scales such as the LANSS to identify the type of choric pain, could be of use to address relevant issues for the patients, and to propose tailored therapies.
Highlights
People living with HIV can experience pain due to different etiologies, and present with a wide spectrum of symptoms that reflect different pain mechanisms: nociceptive, neuropathic or mixed [1]
We explored correlations between psychological factors, pain severity and interference in females living with HIV and chronic pain
We interviewed females living with HIV/AIDS aging between 18 and 65 years old, who were receiving antiretroviral therapy (ART), and asked three screening questions regarding pain: 1) “Are you currently experiencing any pain?”; 2) “Have you felt any pain every day?”; 3) “Has this pain been continuous during the last three months?”
Summary
People living with HIV can experience pain due to different etiologies (e.g. infections, tumors, myopathies, neurological alterations), and present with a wide spectrum of symptoms that reflect different pain mechanisms: nociceptive, neuropathic or mixed [1]. Pain is experienced by 38% of those suffering sensory neuropathy [2], impairing quality of life [3], daily functioning [4] and employment situation [5] Such neuropathic lesion have been attributed to both the infection itself and the use of the specific antiretroviral therapy (ART) with dideoxynucleoside analogues [2], because they induce neuronal and axonal mitochondrial DNA damage [6,7]. Different in their origins, if perseverant both neuropathic and nociceptive pain can unleash peripheral and central nervous system alterations that can translate into chronic pain [8,9], exposing patients to the additional psychological burden that it implies [10]. The burden of the disease according to the type of pain, has not been explored in South America before
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