Abstract
BackgroundPain is one of the most prevalent symptoms in people living with HIV/AIDS and is largely undermanaged. Both a peer-led exercise and education Positive Living programme (PL programme) and the PL programme workbook alone were previously found to be effective in reducing pain in urban amaXhosa Women Living With HIV/AIDS (WLWHA). A therapeutic relationship was hypothesised to have contributed to the efficacy of both interventions. The aim of the study was to determine the effectiveness of the PL programme and a therapeutic relationship, compared to a therapeutic relationship alone in managing pain amongst rural amaXhosa WLWHA on pain severity and pain interference, and secondary outcomes, symptoms of depression, health-related quality of life (HRQoL) and self-efficacy.MethodsIn this two-group, single-blind, pragmatic clinical trial with stratified convenience sampling, the PL programme and therapeutic relationship, was compared to a therapeutic relationship alone in rural amaXhosa WLWHA. The PL programme was a 6-week, peer-led intervention comprising education on living well with HIV, exercise and goal setting. The therapeutic relationship comprised follow-up appointments with a caring research assistant. Outcome measures included pain severity and interference (Brief Pain Inventory), depressive symptoms (Beck Depression Inventory), HRQoL (EuroQol 5-Dimensional outcome questionnaire) and self-efficacy (Self-efficacy for Managing Chronic Disease 6-Item Scale). Follow-up was conducted at 4, 8, 12, 24, and 48 weeks. Mixed model regression was used to test the effects of group, time, and group and time interactions of the interventions on outcome measures.ResultsForty-nine rural amaXhosa WLWHA participated in the study: PL group n = 26; TR group n = 23. Both intervention groups were similarly effective in significantly reducing pain severity and interference and depressive symptoms, and increasing self-efficacy and HRQoL over the 48 weeks. A clinically important reduction in pain severity of 3.31 points occurred for the sample over the 48 weeks of the study. All of these clinical improvements were obtained despite low and suboptimal attendance for both interventions.ConclusionsProviding a therapeutic relationship alone is sufficient for effective pain management amongst rural amaXhosa WLWHA. These findings support greater emphasis on demonstrating care and developing skills to enhance the therapeutic relationship in healthcare professionals working with rural amaXhosa WLWHA.Trial registrationPACTR; PACTR201410000902600, 30th October 2014; https://pactr.samrc.ac.za.
Highlights
Pain is one of the most prevalent symptoms in people living with Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and is largely undermanaged
This research contributes to understanding the use of non-pharmacological interventions, the effects of therapeutic relationships, to improve pain management for people living with HIV/ AIDS (PLWHA), for whom pain is undermanaged internationally [1], and for vulnerable groups, such as women and people in poverty, who commonly receive poor pain management [2, 68,69,70,71]
The current research indicates that the purposeful development of a therapeutic relationship between a caring health care worker and a patient can bring about clinically meaningful changes in pain with significant reductions in pain severity and pain interference for amaXhosa Women Living With HIV/AIDS (WLWHA)
Summary
Pain is one of the most prevalent symptoms in people living with HIV/AIDS and is largely undermanaged. Both a peer-led exercise and education Positive Living programme (PL programme) and the PL programme workbook alone were previously found to be effective in reducing pain in urban amaXhosa Women Living With HIV/AIDS (WLWHA). HIV-associated neuropathic pain may occur as a direct or indirect consequence of the virus, or be secondary to treatments for the virus. HIV-associated nociceptive pain may arise due to acute tissue damage, injury or complications occurring secondary to immune failure. HIV-associated chronic nociplastic pain may arise due to the direct or indirect effects of the virus on the nervous system [1,2,3]. Pain in PLWHA, similar to pain in other chronic conditions, is influenced by a range of biomedical factors such as co-morbidities and immune dysregulation, and a range of psychosocial factors such as poverty, level of education, mood disorders, social isolation and the double burden of living with both HIV and chronic pain, which are both stigmatized conditions [3]
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