| Publication Abstract Display | | Type: Published Manuscript | | Title: Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy. | | Authors: Robinson-Papp J, Morgello S, Vaida F, Fitzsimons C, Simpson D, Elliott K, Al-Lozi M, Gelman B, Clifford D, Marra C, McCutchan J, Atkinson J, Dworkin R, Grant I, Ellis R | | Year: 2010 | | Publication: Pain | | Volume: 151 Issue: Pages: 732-736 | | Abstract:HIV-infected patients frequently report chronic pain to their healthcare providers. According to a recent literature review, the prevalence ranges between 28% to 97% depending on the pain assessment method and the setting of the study.[2] Many authors have decried the high prevalence of pain in HIV as demonstrative of underestimation and undertreatment.[4,8] However there are significant barriers to effective pain management in this population.[11,12,17] A problem common to all types of chronic pain is the lack of objective measures of pain. Other factors are relatively more specific to the HIV-infected population. Psychiatric disorders, which are prevalent among HIV-infected patients, may worsen pain, limit treatment options, and interfere with the establishment of an effective therapeutic relationship between patient and healthcare provider.[7] Substance abuse disorders raise similar issues with the additional complexity of provider concern over the legal, ethical and therapeutic implications of prescribing opiates in this population. Recent guidelines on the treatment of chronic non-cancer pain advise taking such factors into account when weighing the risks and benefits of opioid therapy.[5] There are also cultural barriers to pain control which are important among HIV-infected patients because of the disproportionate number of minority patients affected. These include a historic mistrust of the medical establishment in some minority communities, as well as disparities such as the unequal prescription of analgesia to Hispanics and African-Americans as compared to white patients.[14-16]
A common cause of chronic pain among HIV-infected patients is sensory neuropathy (HIV-SN).[9,13] Typical symptoms of HIV-SN include paresthesias, neuropathic pain and numbness. These symptoms usually occur in a distal symmetric distribution. Neuropathic pain and paresthesias are often the focus of clinical care for HIV-SN, because there are currently no neuroregenerative therapies. Current guidelines for the management of chronic non-cancer pain emphasize the importance of determining the disorder underlying a painful condition,[5] but abnormalities on physical examination may be subtle in HIV-SN. There are validated objective instruments to diagnose neuropathy and measure its severity, such as the total neuropathy score (TNS).[6] However these instruments typically include detailed neurologic assessments that are not practical in most HIV primary care or pain management settings. Accordingly it would be useful to know if a simple self-report of neuropathic pain and/or paresthesias in a distal symmetric distribution is helpful in establishing the diagnosis HIV-SN.
In this study we investigated the association between the self-report of distal neuropathic pain and/or paresthesias (DNPP) and objective signs of sensory abnormality, and assessed whether this relationship is affected by demographics and other factors that commonly complicate pain management in HIV, namely substance use and other psychiatric disorders. |
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