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Ongoing Pain Despite Aggressive Opioid Pain Management Among Persons With HIV

Koeppe, John MD*; Armon, Carl MSPH; Lyda, Karen NP; Nielsen, Craig NP*; Johnson, Steven MD*

doi: 10.1097/AJP.0b013e3181b91624
Original Articles

Background: Chronic pain is a common problem among persons living with HIV and opioids are frequently used in its treatment. However, data on the variables associated with opioids use and the efficacy of this practice are lacking.

Methods: We performed a cross-sectional cohort study of self-reported pain during the year 2005 in our clinic. Patients were grouped into 3 cohorts: those receiving daily opioid therapy for chronic pain (cohort 1, n=115), those with a chronic pain diagnosis but not on daily opioid therapy (cohort 2, n=209), and those without a chronic pain diagnosis (cohort 3, n=796).

Results: In multivariate analysis comparing cohorts 1 and 2, patients in cohort 1 were significantly more likely to be on a benzodiazepine or gamma-aminobutyric receptor agonist [odds ratio (OR)=15.2], have injection drug use as a HIV risk factor (OR=4.27), lack private insurance (OR=3.51), have been abused (OR=3.08), have a history of AIDS (OR=2.21), and be seen more frequently (OR=1.18). Patients in cohort 1 reported significantly more pain [mean pain scores (0 to 10): 4.3 cohort 1; 1.9 cohort 2; 0.7 cohort 3], and were more likely to have pain that was of moderate or greater severity (58.6% cohort 1; 15.5% cohort 2; 4.9% cohort 3).

Conclusions: Psychosocial variables and a history of AIDS were associated with opioid use in our clinic. Persons on opioids continued to experience significantly more pain than other patients in our clinic.

Supplemental Digital Content is available in the article

Division of Infectious Diseases, Departments of *Medicine

Psychiatry, School of Medicine

Graduate School, University of Colorado Denver, Aurora, CO

Sources of Support: None.

Reprints: John Koeppe, MD, Division of Infectious Diseases, Department of Medicine, School of Medicine, 1635 Aurora Court, B-163, University of Colorado Denver, Aurora, CO 80045 (e-mail: john.koeppe@uchsc.edu).

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site, www.clinicalpain.com.

Received for publication December 16, 2008 revised July 9, 2009 accepted July 20, 2009

© 2010 Lippincott Williams & Wilkins, Inc.