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Strategies Used to Manage Chronic Pain in HIV-Disease: Comparing Persons Prescribed Opioids Versus Persons not Receiving Opioids

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Abstract

Chronic pain is common in people living with HIV (PLWH), causes substantial disability and is associated with limitations in daily activities. Opioids are commonly prescribed for pain treatment among PLWH, but evidence of sustained efficacy is mixed. There is little information available on how PLWH who have chronic pain use multimodal strategies in pain management. The current cross-sectional study examined background characteristics, self-reported pain, and the use of other pain treatments among 187 PLWH with chronic pain and depressive symptoms who were and were not prescribed opioids. Approximately 20.9% of participants reported using prescription opioids at the time of the study interview. These individuals were significantly more likely to report having engaged in physical therapy or stretching, strengthening or aerobic exercises in the previous 3 months, recent benzodiazepine use, and receiving disability payments. There were no significant differences in pain characteristics (pain-related interference, average pain severity, and worst pain severity) between the two groups. Those not prescribed opioids were more likely to report better concurrent physical functioning and general health, and fewer physical role limitations, but higher depression symptom severity. Our findings suggest that many PLWH with chronic pain and depressive symptoms express high levels of pain with deficits in physical function or quality of life despite their use of opioids. The high rate of co-use of opioids and benzodiazepines (30.8%) is a concern because it may increase risk of overdose. An integrated care approach that includes a variety of effective non-pharmacologic treatment strategies such as physical therapy may be beneficial in reducing the reliance on opioids for pain management.

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Funding

Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01NR015977 to Drs. Uebelacker and Stein. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA

    Jih-Cheng Yeh & Michael D. Stein

  2. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA

    Lisa A. Uebelacker, Megan M. Pinkston & Ana M. Abrantes

  3. Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA

    Lisa A. Uebelacker

  4. Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA

    Lisa A. Uebelacker, Bradley J. Anderson, Ana M. Abrantes & Michael D. Stein

  5. Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA

    Megan M. Pinkston

  6. Lifespan Physicians Group, The Miriam Hospital, Providence, RI, USA

    Megan M. Pinkston

  7. Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA

    Andrew M. Busch

  8. Department of Medicine, University of Minnesota - Twin Cities, Minneapolis, MN, USA

    Andrew M. Busch & Jason V. Baker

  9. Division of Infectious Diseases, Hennepin County Medical Center, Minneapolis, MN, USA

    Jason V. Baker

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  1. Jih-Cheng Yeh
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Contributions

JCY and MDS conceived of the presented idea. JCY developed the theory and took the lead in writing the manuscript. BJA contributed to the analysis of the results. LU, MMP, AB, AMA, and JB contributed to the design and implementation of the research. LU and MDS designed and directed the project, and supervised the findings of this work. All authors provided critical feedback and helped shape the research, analysis and manuscript.

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Correspondence to Jih-Cheng Yeh.

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Dr. Uebelacker’s spouse is employed by Abbvie Pharmaceuticals. The remaining authors declare that they have no conflict of interest.

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Yeh, JC., Uebelacker, L.A., Pinkston, M.M. et al. Strategies Used to Manage Chronic Pain in HIV-Disease: Comparing Persons Prescribed Opioids Versus Persons not Receiving Opioids. AIDS Behav 27, 3239–3247 (2023). https://doi.org/10.1007/s10461-023-04044-w

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