Attitudes towards exercise among substance using older adults living with HIV and chronic pain

ABSTRACT

Chronic pain and substance use disorders occur commonly among HIV-infected persons. Recent CDC guidelines recommend non-pharmacologic approaches over opioid medications for the management of chronic pain. This is particularly relevant for persons with substance use disorders. Structured physical activity may be an effective strategy for pain reduction. We developed a combined cognitive-behavioral therapy (CBT) + exercise intervention to reduce pain, pain-related disability and substance use and improve physical function in older HIV-infected adults with chronic pain and substance use. We employed established CBT protocols for the intervention, and sought feedback from potential end users when developing the exercise component of the intervention. A total of 27 HIV-infected adults ≥ 50 years of age participated in four focus group sessions. Transcripts were analyzed using thematic analysis. Participant demographics: mean age 54 years; male 81%; Hispanic 48%, Black 33%; treated for substance abuse in the past 52%. Exercise was seen as a desirable activity, but many participants expressed barriers to exercise including fear of pain exacerbation, low physical fitness, and lack of availability of perceived safe spaces for HIV-infected persons. Most participants were receptive to exercise for pain reduction, particularly modalities that provide added psychological benefits of reducing stress and anxiety. Exercise for pain management among older HIV-infected adults with chronic pain and substance use was found to be highly acceptable. However, interventions need to be tailored to the unique needs of this population to address their fears and concerns.

KEYWORDS:

• Older adults
• pain
• substance use
• exercise
• non-pharmacologic approaches

Acknowledgements

Contents are the responsibility of the authors and do not necessarily represent the official views of the sponsoring agencies.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the UCLA Older Americans Independence Center under the National Institute on Aging [grant number P30-AG028748 and 3P30-AG028748-09S1]; National Institute on Alcohol Abuse and Alcoholism under [grant 1 number K24 AA15957-01]; National Institute of Drug Abuse under [grant 1 number R21 DA038163-02]; UCLA RCMAR/CHIME under the National Institute on Aging [grant P30-AG021684]; UCLA CTSI NIH/NCRR/NCATS under [grant number UL1TR000124]; National Institute on Aging [grant number P30AG022845; K24AG053462; K23AI110532 to JEL] and by the Howard and Phyllis Schwartz Philanthropic Fund.