Prevalence of pain and association with psychiatric symptom severity in perinatally HIV-infected children as compared to controls living in HIV-affected households

Abstract

This cross-sectional study evaluated the prevalence of pain and psychiatric symptoms in perinatally HIV-infected children at entry into P1055, a multicenter investigation of the prevalence and severity of psychiatric symptoms in HIV-infected children. Subjects 6–17 years of age and their primary caregivers were recruited from 29 International Maternal Pediatric Adolescent AIDS Clinical Trials sites in the USA and Puerto Rico. A total of 576 children (320 HIV+ and 256 HIV– children) were enrolled from June 2005 to September 2006. Subject self-reports of pain were measured by the Wong–Baker visual analog scale and Short-Form McGill Pain Questionnaire. Symptomatology for anxiety, depression, and dysthymia was assessed through Symptom Inventory instruments. Caregiver's assessment of their child's pain and psychiatric symptomatology was similarly measured. Logistic regression models were used to evaluate predictors of pain. We found that a higher proportion of HIV-infected than uninfected subjects reported pain in the last two months (41% vs 32%, p=0.04), last two weeks (28% vs 19%, p=0.02), and lasting more than one week (20% vs 11%, p=0.03). Among HIV-infected youth, females (OR = 1.53, p=0.09), White race (OR = 2.15, p=0.04), and Centers for Disease Control (CDC) class C (OR = 1.83, p = 0.04) were significantly more likely to report pain. For all subjects, only 52% of caregivers recognized their child's pain and just 22% were aware that pain affected their child's daily activities. The odds of reported pain in HIV+ increased with higher symptom severity for generalized anxiety (OR = 1.14, p = 0.03), major depression (OR = 1.15, p=0.03), and dysthymia (OR = 1.18, p=0.01). This study underscores the importance of queries concerning pain and emotional stressors in the care of HIV+ and uninfected children exposed to HIV+ individuals. The discordance between patient and caregiver reports of pain and its impact on activities of daily living highlights that pain in children is under-recognized and therefore potentially under-treated.

Keywords:

• pain
• HIV
• children

Acknowledgements

This work was supported by the National Institute of Allergy and Infectious Diseases Pediatric AIDS Clinical Trials Group, the National Institute of Child Health Pediatric and Perinatal HIV Clinical Trials Network, the National Institute of Mental Health, and National Institute of Allergy and Infectious Diseases cooperative agreement (AI-41110) for the Statistical and Data Management Center of IMPAACT. We would like to thank Kimberly Hudgens for her operational support of this study as well as Janice Hodge for data management.

The following institutions and individuals participated in IMPAACT P1055: San Juan City Hospital, Puerto Rico: M. Acevedo-Flores, L. Angeli, M. Gonzalez, D. Guzman; Yale University School of Medicine: W. Andiman, L. Hurst, A Murphy, SUNY-Stony Brook: D. Ferraro, M. Kelly, L. Rubino; University of South Florida – Tampa: P. Emmanuel, J. Lujan Zilberman, C. Rodriguez, C. Graisbery; Harbor UCLA Medical Center: M. Keller, S. Wettgen, S. Sullivan, J. Hayes; Duke University Medical Center: K. Whitfield, S. Patil, J. Wilson, MJ. Hassett; UCSD Maternal, Child, and Adolescent HIV: S. Spector, L. Stangl, M. Caffery, R. Viani; Tulane/LSU Maternal/Child M. Silio, T. Alchediak, C. Borne, S. Bradford; University of Florida Jacksonville: M. Rathore, A. Mirza, K. Thoma, C. Griggs; New York University: S. Deygoo, W. Borkowsky, S. Chandwani, M. Rigaud; Mount Sinai School of Medicine, NY: R. Posada, M. Dolan; UCLA-Los Angeles/Brazil AIDS Consortium (LABAC): K. Nielsen, N. Falgout, J. Geffen, J. Deville; University of Colorado-Denver: R. McEvoy, E. Barr, S. Paul, P. Michalek; Harvard Medical School-Children's Hospital Boston: S. Burchett; Long Beach Memorial Medical Center, Miller Children's Hospital: A. Deveikis; Harbor-UCLA Medical Center, Harbor: M. Keller; University of Maryland Medical Center: V. Tepper; Children's Memorial Hospital-Chicago: R. Yogev; University of Miami: G. Scott; UCSF Pediatric AIDS: D. Wara; Jacobi Medical Center-Bronx: A. Wiznia; University of Washington Children's Hospital Seattle: L. Frenkel; SUNY Upstate Medical University: L. Weiner; Wayne State University Detroit: E. Moore; Howard University-Washington DC: S. Rana; University of Southern California-Los Angeles: S. Kapetanovic; South Florida Children's Diagnostic and Treatment Center-Ft Lauderdale: A. Puga; St. Jude Research Hospital-Memphis, TN: P. Garvie;

The Children's Hospital of Philadelphia: R. Rutstein; St. Christopher's Hospital for Children-Philadelphia: R. LaGuerre; Bronx-Lebanon Hospital: M. Purswani; St. Luke's-Roosevelt Hospital Center-NY: S. Arpadi; University of Massachusetts Medical School: K. Luzuriaga; Metropolitan Hospital Center-NY: M. Bamji.

The first and corresponding authors attest to having full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.