Predictors of pain-related functional impairment among people living with HIV on long-term opioid therapy

ABSTRACT

People living with HIV (PLWH) have high levels of functional impairment due to pain, also called pain interference. Long-term opioid therapy (LTOT) is commonly prescribed for chronic pain among PLWH. We sought to better understand the predictors of pain interference, measured with the Brief Pain Inventory Interference subscale (BPI-I), among PLWH with chronic pain on LTOT. Using a prospective cohort of PLWH on LTOT we developed a model to identify predictors of increased pain interference over 1 year of follow up. Participants (n = 166) were 34% female, 72% African American with a median age of 55 years, and 40% had severe pain interference (BPI-I ≥ 7). In multivariable models, substance use disorder, depressive symptoms, PTSD symptoms, financial instability, and higher opioid doses were associated with increased pain interference. Measures of behavioral health and socioeconomic status had the most consistent association with pain interference. In contrast, the biomedical aspects of chronic pain and LTOT – comorbidities, duration of pain – were not predictive of pain interference. PLWH with chronic pain on LTOT with lower socioeconomic status and behavioral health symptoms have higher risk of pain interference. Addressing the social determinants of health and providing access to behavioral health services could improve patients’ pain-related functional status.

KEYWORDS:

• Chronic pain
• opioid use
• social determinants of health

Acknowledgements

We would like to thank the study participants who generously donated their time and personal insights to make this work possible. We thank the staff at Emory, Grady, and BMC for their dedication to this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Supported by NIDA [grant number R01DA037768 to J. H. S. and C. d. R.], and by Center for AIDS Research Emory University [grant number P30AI050409 to C. d. R. and J. A. C.] and the Providence/Boston Center for AIDS Research [grant number P30AI042853].