Association Between Diagnoses of Chronic Noncancer Pain, Substance Use Disorder, and HIV-Related Outcomes in People Living With HIV.
JAIDS Journal of Acquired Immune Deficiency Syndromes. 2019-12-01; 82: S142-S147
DOI: 10.1097/QAI.0000000000002179
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BACKGROUND: Chronic pain is common in people living with HIV (PLWH). Few studies
have evaluated the association between the diagnoses of chronic pain, substance
use disorder (SUD), and HIV-related outcomes in clinical settings over a 10-year
period.
METHODS: Using electronic medical records, the study described psychiatric
diagnoses, pain medication, and HIV-related variables in PLWH and examined the
factors associated with pain diagnosis and HIV-related outcomes.
RESULTS: Among 3528 PLWH, more than one-third exhibited a chronic pain diagnosis
and more than one-third a psychiatric disorder. Chronic pain diagnosis has been
associated with SUD and mood and anxiety disorders and occurred before SUD or
psychiatric disorders about half of the time. Opioids have been commonly
prescribed for pain management, more often than nonopioid analgesic, without any
change in prescription pattern over the 10-year period. A dual diagnosis of pain
and SUD has been associated with more psychiatric disorders and had a negative
impact on the pain management by requesting more health care utilization and
higher frequency of both opioid and nonopioid medication prescriptions. Chronic
pain and SUD had a negative impact on ART adherence. SUD but not chronic pain has
been associated with an unsuppressed HIV viral load.
CONCLUSIONS: In the current intertwining opioid prescription and opioid epidemic,
opioids are still commonly prescribed in PLWH in HIV care. A diagnosis of chronic
pain and/or SUD worsened the HIV-related outcomes, emphasizing the potential risk
of the HIV epidemic. These findings called for a better coordinated care program
in HIV clinics.
DOI: 10.1097/QAI.0000000000002179
PMCID: PMC6822377
PMID: 31658202