Three studies investigated posttraumatic stress. These studies are reported separate from studies measuring psychological distress, given the specificity of posttraumatic stress as a variable. Different study designs and analyses precluded meta-analysis. One prospective study (n = 143) found that posttraumatic stress symptoms (PTSSs) were associated with significantly higher pain severity and interference over time in a sample with HIV and persistent pain.107 One high-quality cross-sectional study found that participants with pain (n = 170) had significantly higher PTSS than those without pain (n = 59).79 Within the pain group in this study, there was a nonsignificant correlation between PTSSs and pain severity, and small but significant correlations between PTSSs and pain interference (positive correlation) and quality of life (negative correlation).79 Posttraumatic stress disorder did not differ between groups with (n = 150) and without (n = 128) neuropathy in another cross-sectional study.31
Fourteen studies examined drug abuse. We prioritised extracting opioid abuse data when multiple drug abuse categories were reported, given the relevance of opioid use in chronic pain. Two prospective studies reported ORs for pain predicting heroin use at the time of follow-up. The pooled OR indicated that participants with pain at baseline were more likely at follow-up to be using heroin: OR = 1.70 (95% CI 1.22-2.38), z = 3.13, P = 0.002 (supplemental Figure 10, available at http://links.lww.com/PAIN/A643). Heterogeneity was low (I2 = 14.0%). Conversely, another prospective study (n = 493) reported that baseline opioid use disorder history predicted new onset of neuropathic pain, OR = 2.87 (1.31-6.28), P < 0.01.60 One low-quality prospective study (n = 127) found that baseline drug abuse history did not predict the presence of pain at follow-up, 0.55 (0.25-1.21).54 These 2 studies could not be combined due to different coding of the dependent variable.
Eleven studies investigated alcohol abuse. Two prospective studies reported ORs for baseline pain predicting subsequent alcohol abuse. The pooled OR was not significant: OR = 0.94 (95% CI 0.39-2.26), z = 0.13, P = 0.90 (supplemental Figure 11, available at http://links.lww.com/PAIN/A643). Heterogeneity was high (84.1%). Two additional prospective studies examined baseline alcohol abuse as a predictor of developing pain/neuropathy but could not be combined due to different analyses. Both studies reported a nonsignificant association between these variables.60,77 Seven cross-sectional studies provided events data or ORs. The pooled OR was not significant: OR = 1.22 (95% CI 0.92-1.62), z = 1.36, P = 0.17 (supplemental Figure 12, available at http://links.lww.com/PAIN/A643). Heterogeneity was medium (I2 = 39.0%).
Three studies investigated sleep disturbance. Two cross-sectional studies reported mean values and SDs. The pooled effect was significant and showed moderately greater sleep problems in participants with vs without pain: SMD = 0.66 (95% CI 0.45-0.87), z = 6.12, P < 0.001. Heterogeneity was 0.0% (supplemental Figure 13, available at http://links.lww.com/PAIN/A643). Another cross-sectional (n = 45) study reported a significant correlation between pain severity and sleep disturbance, and a nonsignificant correlation between sleep and functioning.94
Six studies examined health care use. One prospective study (n = 1521) found that baseline pain predicted significantly higher odds (OR = 1.6, 95% CI 1.2-2.0) of urgent care visits.68 Two cross-sectional studies reported events data. The pooled OR was not significant: OR = 0.98 (95% CI 0.58-1.66, z = 0.07, P = 0.94) (supplemental Figure 16, available at http://links.lww.com/PAIN/A643). Heterogeneity was 0.0%. Two further cross-sectional studies reported mean values and SDs. The pooled effect was small but significant, such that participants with pain had greater health care use than those without pain: SMD = 0.36 (95% CI 0.21-0.51, z = 4.66, P < 0.001). Heterogeneity was 0.0% (supplemental Figure 17, available at http://links.lww.com/PAIN/A643). One further cross-sectional study (n = 1120) found that participants with pain and daily opioid use had more clinic visits than those with pain without daily opioid use and those without pain (SD not reported).53
Seven cross-sectional studies provided events data or ORs for the association between unemployment and pain. The pooled OR was significant and indicated that participants with pain had higher odds of being unemployed than those without pain: OR = 2.09 (95% CI 1.59-2.76, z = 5.25, P < 0.001) (supplemental Figure 19, available at http://links.lww.com/PAIN/A643). Heterogeneity was moderate (48.6%). One further cross-sectional study (n = 229) that did not have data available for meta-analysis likewise found that participants with pain were significantly more likely to be unemployed than those without pain.79
Five studies examined protective psychological factors. One prospective study (n = 62) found significant small and medium correlations between change in self-reported pain acceptance during CBT and posttreatment pain severity and interference, respectively.86 One cross-sectional case-control study observed lower resilience in participants with (n = 99) vs without pain (n = 98; medium effect); however, this study found nonsignificant correlations between resilience and pain severity and interference in the pain group.121
Four studies investigated social factors. The BEACON study (n = 377) explored social processes across 3 papers, 2 of which describe prospective data (medium quality), whereas the third reported cross-sectional data (low quality). Baseline chronic pain predicted “negative social support” (ie, overly intrusive or insensitive responses from others and a lack of support) at 12 months, controlling for baseline social support.73 Another prospective analysis showed that no chronic pain at baseline predicted greater support reciprocity at follow-up.74 Chronic pain was associated with significantly poorer ratings of patient–provider engagement in cross-sectional analyses.72
Two studies examined self-reported stigma, but could not be combined. One medium-quality cross-sectional study (n = 50) found a moderate positive correlation between stigma and pain severity.122 One low-quality cross-sectional study (n = 201) found that participants with “pain disorder” reported higher stigma scores than those without “pain disorder.”98 One medium-quality cross-sectional study found no difference in mean number or quality of self-reported social supports between participants with (n = 274) and without pain (n = 164).91
This review including over 13,000 participants found “some” or “moderate” evidence supporting an association between pain outcomes and depression, psychological distress, posttraumatic stress, drug abuse, sleep disturbance, health care use, missed HIV clinic visits, ART adherence, unemployment, and protective psychological factors in people with HIV. Surprisingly few studies have examined protective psychological factors or social processes. There is a lack of high-quality research on psychosocial factors related to chronic pain in people with HIV. These findings can inform future research and treatment development in this area.
There was substantial variability in the assessment of “psychological distress,” which may have contributed to the statistical heterogeneity observed. Although different measures were used to assess variables such as pain catastrophizing, pain-related fear, stress, and general anxiety, these measures overlap conceptually and in item content. The consistency of results within the psychological distress category suggests the findings are robust across different assessment methods. Several studies assessed “mental illness” based on a range of diagnoses in participants' medical file without clear diagnostic criteria. Studies exploring mental health diagnoses should use valid and reliable criteria and, ideally, semi-structured clinician-administered interviews as the gold standard.128 In light of high rates of posttraumatic stress disorder (PTSD) in HIV,99 further research is particularly needed to understand the role of PTSD in pain in this context. Alternately, rather than focusing on specific mental health diagnoses, research investigating psychosocial processes that explain the impact of a range of psychological difficulties may prove useful moving forward.42
Surprisingly, only 5 studies assessed protective psychological factors. The lack of studies on protective factors mirrors historical trends in the general pain literature, although there has been greater focus on protective factors more recently. The focus on “maladaptive” responses to pain is problematic because such responses can be understood as a function of their short-term utility.126 Moreover, abnormal conceptualizations often fail to specify pathways through which recovery and successful functioning occur when pain is present. The psychological flexibility model, within which pain acceptance has been conceptualised, might prove useful for future research.63
The study samples included in our review varied widely in terms of the proportion of men and women, participant age, ethnicity, and duration and severity of HIV. Our sensitivity analyses support the potential applicability of findings across pain types, ART treatment eras, and health care systems. Due to poor reporting of viral loads and CD4+ counts, our analysis stratifying by these indicators is difficult to interpret. Caution is also warranted regarding the cross-cultural applicability of the findings because most studies were from the United States. One South African study with a predominantly female sample found patients with and without pain did not differ on depression or anxiety, likely due to high scores across the sample.88 Socioeconomic factors, such as poverty and gender, may thus alter the relationships between pain, functioning, and mental health.88,121 Care is needed in applying Western psychological concepts in non-Western cultures.51,82,83 Research must also determine unique cultural features that influence the experience and expression of pain in HIV.
A guiding theoretical model is needed to integrate psychosocial processes relevant to pain and HIV. Such a model should make specific predictions about the relative contributions of cognitive, affective, behavioural, and sociocultural processes in relation to specific pain outcomes. This review identified a number of closely related psychosocial constructs. Therefore, a theoretical model may benefit from identifying a key set of nonoverlapping variables.63 This may draw on prominent models within the field of pain, such as the fear-avoidance19 and psychological flexibility models,63 and those within the HIV literature that focus heavily on sociocultural perspectives to understand the impact of processes, such as stigma, on well-being.78
The current findings suggest the relevance of psychosocial treatments to manage persistent pain in HIV. To the best of our knowledge, only 3 small RCTs have evaluated CBT and mindfulness-based treatment.29,35,118 Nonrandomized trials of CBT113 and hypnosis25 have also been conducted. Further evaluation of psychosocial treatments for HIV and chronic pain is thus needed. The development of treatments that specifically target psychosocial factors identified in this review with “some” or “moderate” evidence may prove fruitful.
Several limitations warrant consideration. We used a comprehensive search strategy that included efforts to identify gray literature to limit publication bias; however, relevant studies may have been missed, given the broad nature of the search. We used an adapted quality assessment tool. Although we based this on previously validated tools, the adaptations may have limited the reliability and validity of our quality assessment. Assessment of pain was inadequate in many studies. Future research should assess information regarding pain duration, intensity, location, and type. Studies investigating chronic pain should specify eligibility criteria in line with recognized definitions: the presence of daily, clinically meaningful pain intensity and functional interference for at least 3 months.10,26,131 Given the relevance of neuropathic pain in this population, the use of well-validated screening tools of neuropathy signs and symptoms is important.16,33,129
The authors have no conflict of interest to declare.
This research is an independent work supported by the National Institute for Health Research (NIHR Postdoctoral Fellowship, W. Scott, PDF-2015-08-059). L.M. McCracken is partly funded through the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health. Dr. Kemp reports grants from the European Commission (FP7 Neuropain #HEALTH F2-2013-602891) during the conduct of the study. Dr. Rice reports grants from Orion Pharma, other from Spinifex/Novartis, personal fees from Imperial College Consultants, outside the submitted work. In addition, Dr. Rice has a patent, Rice A.S.C., Vandevoorde S. and Lambert D.M Methods using N-(2-propenyl)hexadecanamide and related amides to relieve pain. WO 2005/079771 pending, and a patent, Okuse K. et al., Methods of treating pain by inhibition of vgf activity EP13702262.0/ WO2013 110945, pending.
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. Ali R, Meena S, Eastwood B, Richards I, Marsden J. Ultra-rapid screening for substance-use disorders: the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-Lite). Drug Alcohol Depend 2013;132:352–61.
. Aouizerat BE, Miaskowski CA, Gay C, Portillo CJ, Coggins T, Davis H, Pullinger CR, Lee KA. Risk factors and symptoms associated with pain
-infected adults. J Assoc Nurses AIDS Care 2010;21:125–33.
. Ariëns GA, Mechelen Wv, Bongers PM, Bouter LM, van der Wal G. Psychosocial risk factors for neck pain
: a systematic review
. Am J Ind Med 2001;39:180–93.
. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain
comorbidity—a literature review. Arch Intern Med 2003;163:2433–45.
. Bakka JC. The relationships of physical functioning, psychological distress, and negative thoughts to pain
in people with AIDS [doctoral thesis]. Ann Arbor: UMI Company, 1995.
. Banerjee S, McCutchan JA, Ances BM, Deutsch R, Riggs PK, Way L, Ellis RJ. Hypertriglyceridemia in combination antiretroviral-treated HIV
-positive individuals: potential impact on HIV
sensory polyneuropathy. AIDS 2011;25:F1–6.
. Banks SM, Kerns RD. Explaining high rates of depression in chronic pain
: a diathesis-stress framework. Psychol Bull 1996;119:95–110.
. Berg KM, Cooperman NA, Newville H, Arnsten JH. Self-efficacy and depression as mediators of the relationship between pain
and antiretroviral adherence. AIDS Care 2009;21:244–8.
. Bor J, Herbst AJ, Newell ML, Bärnighausen T. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV
treatment. Science 2013;339:961–5.
. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain
with neuropathic characteristics in the general population. PAIN
. Breitbart W, McDonald MV, Rosenfeld B, Passik SD, Hewitt D, Thaler H, Portenoy RK. Pain
in ambulatory AIDS patients. I: pain
characteristics and medical correlates. PAIN
. Breitbart W, Passik S, McDonald MV, Rosenfeld B, Smith M, Kaim M, Funesti-Esch J. Patient-related barriers to pain
management in ambulatory AIDS patients. PAIN
. Breitbart W, Rosenfeld B, Passik S, Kaim M, Funesti-Esch J, Stein K. A comparison of pain
report and adequacy of analgesic therapy in ambulatory AIDS patients with and without a history of substance abuse. PAIN
. Campbell LC, Clauw DJ, Keefe FJ. Persistent pain
and depression: a biopsychosocial perspective. Biol Psychiatry 2003;54:399–409.
. Cherry CL, Wadley AL, Kamerman PR. Painful HIV
-associated sensory neuropathy. Pain
. Cherry CL, Wesselingh SL, Lal L, McArthur JC. Evaluation of a clinical screening tool for HIV
-associated sensory neuropathies. Neurology 2005;65:1778–81.
. Clifford DB, Simpson DM, Brown S, Moyle G, Brew BJ, Conway B, Tobias JK, Vanhove GF. A randomized, double-blind, controlled study of NGX-4010, a capsaicin 8% dermal patch, for the treatment of painful HIV
-associated distal sensory polyneuropathy. J Acquir Immune Defic Syndr 2012;59:126–33.
. Corey DM, Dunlap WP, Burke MJ. Averaging correlations: expected values and bias in combined Pearson rs and Fisher's z transformations. J Gen Psychol 1998;125:245–61.
. Crombez G, Eccleston C, Van Damme S, Vlaeyen JWS, Karoly P. Fear-avoidance model of chronic pain
: the next generation. Clin J Pain
. Crombez G, Vlaeyen JWS, Heuts PHTG, Lysens R. Pain
-related fear is more disabling than pain
itself: evidence on the role of pain
-related fear in chronic back pain
. Cucciare MA, Sorrell JT, Trafton JA. Predicting response to cognitive-behavioral therapy in a sample of HIV
-positive patients with chronic pain
. J Behav Med 2009;32:340–8.
. Davis L, Evans S, Fishman B, Haley A, Spielman L. Predictors of attrition in HIV
-positive subjects with peripheral neuropathic pain
. AIDS Care 2004;16:395–402.
. De Ruddere L, Craig KD. Understanding stigma and chronic pain
: a state of the art review. PAIN
. Dinat N, Marinda E, Moch S, Rice AS, Kamerman PR. Randomized, double-blind, crossover trial of amitriptyline for analgesia in painful HIV
-associated sensory neuropathy. PLoS One 2015;10:e0126297.
. Dorfman D, George MC, Schnur J, Simpson DM, Davidson G, Montgomery G. Hypnosis for treatment of HIV
: a preliminary report. Pain
. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N. Core outcome measures for chronic pain
clinical trials: IMMPACT recommendations. PAIN
. Ellis RJ, Rosario D, Clifford DB, McArthur JC, Simpson D, Alexander T, Gelman BB, Vaida F, Collier A, Marra CM. Continued high prevalence and adverse clinical impact of human immunodeficiency virus–associated sensory neuropathy in the era of combination antiretroviral therapy: the CHARTER Study. Arch Neurol 2010;67:552–8.
. Evans S, Ferrando S, Sewell M, Goggin K, Fishman B, Rabkin J. Pain
and depression in HIV
illness. Psychosomatics 1998;39:528–35.
. Evans S, Fishman B, Spielman L, Haley A. Randomized trial of cognitive behavior therapy versus supportive psychotherapy for HIV
-related peripheral neuropathic pain
. Psychosomatics 2003;44:44–50.
. Evans S, Weinberg BA, Spielman L, Fishman B. Assessing negative thoughts in response to pain
among people with HIV
. Fellows RP, Byrd DA, Elliott K, Robinson-Papp J, Mindt MR, Morgello S. Distal sensory polyneuropathy is associated with neuropsychological test performance among persons with HIV
. J Int Neuropsychol Soc 2012;18:898–907.
. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpää M, Hansson P, Jensen TS. Pharmacotherapy for neuropathic pain
in adults: a systematic review
and meta-analysis. Lancet Neurol 2015;14:162–73.
. Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DL, Bouhassira D, Cruccu G, Freeman R, Hansson P, Nurmikko T. Neuropathic pain
: an updated grading system for research and clinical practice. PAIN
. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain
: scientific advances and future directions. Psychol Bull 2007;133:581.
. George MC, Wongmek A, Kaku M, Nmashie A, Robinson-Papp J. A mixed-methods pilot study of mindfulness-based stress reduction for HIV
-associated chronic pain
. Behav Med 2017;43:108–19.
. Golin C, Isasi F, Bontempi JB, Eng E. Secret pills: HIV
-positive patients' experiences taking antiretroviral therapy in North Carolina. AIDS Educ Prev 2002;14:318–29.
. Gøtzsche PC. Why we need a broad perspective on meta-analysis: it may be crucially important for patients. BMJ 2000;321:585.
. Griswold GA, Evans S, Spielman L, Fishman B. Coping strategies of HIV
patients with peripheral neuropathy. AIDS Care 2005;17:711–20.
. Hansen L, Penko J, Guzman D, Bangsberg DR, Miaskowski C, Kushel MB. Aberrant behaviors with prescription opioids and problem drug use history in a community-based cohort of HIV
-infected individuals. J Pain
Symptom Manage 2011;42:893–902.
. Harrison AM, McCracken LM, Bogosian A, Moss-Morris R. Towards a better understanding of MS pain
: a systematic review
of potentially modifiable psychosocial factors
. J Psychosom Res 2015;78:12–24.
. Hasin DS, O'Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, Compton WM, Crowley T, Ling W, Petry NM. DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry 2013;170:834–51.
. Hayes SC, Barnes-Holmes D, Wilson KG. Contextual behavioral science: creating a science more adequate to the challenge of the human condition. J Context Behav Sci 2012;1:1–16.
. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Chichester: Wiley-Blackwell, 2011.
. Huggins JL, Bonn-Miller MO, Oser ML, Sorrell JT, Trafton JA. Pain
anxiety, acceptance, and outcomes among individuals with HIV
and chronic pain
: a preliminary investigation. Behav Res Ther 2012;50:72–8.
. Ioannidis JP, Patsopoulos NA, Rothstein HR. Research methodology: reasons or excuses for avoiding meta-analysis in forest plots. BMJ 2008;336:1413.
. Jeevanjee S, Penko J, Guzman D, Miaskowski C, Bangsberg DR, Kushel MB. Opioid analgesic misuse is associated with incomplete antiretroviral adherence in a cohort of HIV
-infected indigent adults in San Francisco. AIDS Behav 2014;18:1352–8.
. Jiao JM, So E, Jebakumar J, George MC, Simpson DM, Robinson-Papp J. Chronic pain
disorders in HIV
primary care: clinical characteristics and association with healthcare utilization. PAIN
. Keltner JR, Vaida F, Ellis RJ, Moeller-Bertram T, Fitzsimmons C, Duarte NA, Robinson-Papp J, Dworkin RH, Clifford DB, McArthur JC, Simpson DM, Collier AC, Marra CM, Atkinson J, Grant I. Health-related quality of life “well-being” in HIV
distal neuropathic pain
is more strongly associated with depression severity than with pain
intensity. Psychosomatics 2012;53:380–6.
. King T, Ossipov MH, Vanderah TW, Porreca F, Lai J. Is paradoxical pain
induced by sustained opioid exposure an underlying mechanism of opioid antinociceptive tolerance? Neurosignals 2005;14:194–205.
. Kirkland KE. Psychological factors in HIV
-related headaches [doctoral thesis]. Ann Arbor: UMI Company, 2012.
. Kirmayer LJ. Beyond the “new cross-cultural psychiatry”: cultural biology, discursive psychology and the ironies of globalization. Transcult Psychiatry 2006;43:126–44.
. Knowlton AR, Nguyen TQ, Robinson AC, Harrell PT, Mitchell MM. Pain
symptoms associated with opioid use among vulnerable persons with HIV
: an exploratory study with implications for palliative care and opioid abuse prevention. J Palliat Care 2015;31:228–33.
. Koeppe J, Armon C, Lyda K, Nielsen C, Johnson S. Ongoing pain
despite aggressive opioid pain
management among persons with HIV
. Clin J Pain
. Koeppe J, Lyda K, Johnson S, Armon C. Variables associated with decreasing pain
among persons living with human immunodeficiency virus: a longitudinal follow-up study. Clin J Pain
. Lagana L, Chen X, Koopman C, Classen C, Kimerling R, Spiegel D. Depressive symptomatology in relation to emotional control and chronic pain
in persons who are HIV
positive. Rehab Psychol 2002;47:402–14.
. Lopez O, Becker J, Dew MA, Caldararo R. Risk modifiers for peripheral sensory neuropathy in HIV
infection/AIDS. Eur J Neurol 2004;11:97–102.
. Lucey BP, Clifford DB, Creighton J, Edwards RR, McArthur JC, Haythornthwaite J. Relationship of depression and catastrophizing to pain
, disability, and medication adherence in patients with HIV
-associated sensory neuropathy. AIDS Care 2011;23:921–8.
. Lum PJ, Little S, Botsko M, Hersh D, Thawley RE, Egan JE, Mitty J, Boverman J, Fiellin DA, Collaborative B. Opioid-prescribing practices and provider confidence recognizing opioid analgesic abuse in HIV
primary care settings. J Acquir Immune Defic Syndr 2011;56:S91–7.
. Mahungu TW, Rodger AJ, Johnson MA. HIV
as a chronic disease. Clin Med (Lond) 2009;9:125–8.
. Malvar J, Vaida F, Sanders CF, Atkinson JH, Bohannon W, Keltner J, Robinson-Papp J, Simpson DM, Marra CM, Clifford DB, Gelman B, Fan J, Grant I, Ellis RJ, Group C. Predictors of new-onset distal neuropathic pain
-infected individuals in the era of combination antiretroviral therapy. PAIN
. Mann R, Sadosky A, Schaefer C, Baik R, Parsons B, Nieshoff E, Stacey BR, Tuchman M, Nalamachu S. Burden of HIV
-related neuropathic pain
in the United States. J Int Assoc Provid AIDS Care 2016;15:114–25.
. McAuley L, Tugwell P, Moher D. Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? Lancet 2000;356:1228–31.
. McCracken LM, Morley S. The psychological flexibility model: a basis for integration and progress in psychological approaches to chronic pain
management. J Pain
. McWilliams LA, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain
: an examination in a nationally representative sample. PAIN
. Merlin JS, Cen L, Praestgaard A, Turner M, Obando A, Alpert C, Woolston S, Casarett D, Kostman J, Gross R, Frank I. Pain
and physical and psychological symptoms in ambulatory HIV
patients in the current treatment era. J Pain
Symptom Manage 2012;43:638–45.
. Merlin JS, Westfall AO, Chamot E, Saag M, Walcott M, Ritchie C, Kertesz S. Quantitative evaluation of an instrument to identify chronic pain
-infected individuals. AIDS Res Hum Retroviruses 2015;31:623–7.
. Merlin JS, Westfall AO, Heath SL, Goodin BR, Stewart JC, Sorge RE, Younger J. Brief report: IL-1beta levels are associated with chronic multisite pain
in people living with HIV
. J Acquir Immune Defic Syndr 2017;75:e99–e103.
. Merlin JS, Westfall AO, Raper JL, Zinski A, Norton WE, Willig JH, Gross R, Ritchie CS, Saag MS, Mugavero MJ. Pain
, mood, and substance abuse in HIV
: implications for clinic visit utilization, ART adherence, and virologic failure. J Acquir Immune Defic Syndr 2012;61:164.
. Merlin JS, Zinski A, Norton WE, Ritchie CS, Saag MS, Mugavero MJ, Treisman G, Hooten WM. A conceptual framework for understanding chronic pain
in patients with HIV
. Miaskowski C, Penko JM, Guzman D, Mattson JE, Bangsberg DR, Kushel MB. Occurrence and characteristics of chronic pain
in a community-based cohort of indigent adults living with HIV
infection. J Pain
. Miles MS, Isler MR, Banks BB, Sengupta S, Corbie-Smith G. Silent endurance and profound loneliness: socioemotional suffering in African Americans living with HIV
in the rural south. Qual Health Res 2011;21:489–501.
. Mitchell M, Nguyen T, Maragh-Bass A, Isenberg S, Beach M, Knowlton A. Patient-provider engagement and chronic pain
in drug-using, primarily African American persons living with HIV
/AIDS. AIDS Behav 2017;21:1768–74.
. Mitchell MM, Maragh-Bass AC, Nguyen TQ, Isenberg S, Knowlton AR. The role of chronic pain
and current substance use in predicting negative social support among disadvantaged persons living with HIV
/AIDS. AIDS Care 2016;28:1280–6.
. Mitchell MM, Isenberg SR, Maragh-Bass AC, Knowlton AR. Chronic pain
predicting reciprocity of support among vulnerable, predominantly African-American persons living with HIV
/AIDS. AIDS Behav 2018;22:2002–7.
. Moher D, Liberati A, Tetzlaff J, Altman DG; Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.
. Morgello S, Estanislao L, Simpson D, Geraci A, DiRocco A, Gerits P, Ryan E, Yakoushina T, Khan S, Mahboob R, Naseer M, Dorfman D, Sharp V. HIV
-associated distal sensory polyneuropathy in the era of highly active antiretroviral therapy: the Manhattan HIV
Brain Bank. Arch Neurol 2004;61:546–51.
. Nakamoto BK, McMurtray A, Davis J, Valcour V, Watters MR, Shiramizu B, Chow DC, Kallianpur K, Shikuma CM. Incident neuropathy in HIV
-infected patients on HAART. AIDS Res Hum Retroviruses 2010;26:759–65.
. Parker R, Aggleton P. HIV
and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med 2003;57:13–24.
. Parker R, Jelsma J, Stein DJ. Pain
in amaXhosa women living with HIV
/AIDS: a cross-sectional study of ambulant outpatients. BMC Womens Health 2017;17:126–32.
. Parker R, Stein DJ, Jelsma J. Pain
in people living with HIV
/AIDS: a systematic review
. J Int AIDS Soc 2014;17:18719.
. Passik SD, Kirsh KL, Donaghy KB, Portenoy RK. Pain
and aberrant drug-related behaviors in medically ill patients with and without histories of substance abuse. Clin J Pain
. Patel V. Cultural factors and international epidemiology: depression and public health. Br Med Bull 2001;57:33–45.
. Patel V, Abas M, Broadhead J, Todd C, Reeler A. Depression in developing countries: lessons from Zimbabwe. BMJ 2001;322:482–4.
. Phillips TJ, Brown M, Ramirez JD, Perkins J, Woldeamanuel YW, Williams ACdC, Orengo C, Bennett DL, Bodi I, Cox S, Maier C, Krumova EK, Rice AS. Sensory, psychological, and metabolic dysfunction in HIV
-associated peripheral neuropathy: a cross-sectional deep profiling study. PAIN
. Phillips TJ, Cherry CL, Cox S, Marshall SJ, Rice AS. Pharmacological treatment of painful HIV
-associated sensory neuropathy: a systematic review
and meta-analysis of randomised controlled trials. PLoS One 2010;5:e14433.
. Pierson HM. The role of acceptance in cognitive behavioral treatment for chronic pain
in an HIV
-positive community sample [doctoral thesis]. Ann Arbor: UMI Company, 2009.
. Pike A, Hearn L, Williams ACDC. Effectiveness of psychological interventions for chronic pain
on health care use and work absence: systematic review
and meta-analysis. PAIN
. Pillay P, Wadley AL, Cherry CL, Karstaedt AS, Kamerman PR. Psychological factors associated with painful versus non-painful HIV
-associated sensory neuropathy. AIDS Behav 2018;22:1584–95.
. Robbins NM, Chaiklang K, Supparatpinyo K. Undertreatment of pain
plus adults in Thailand. J Pain
Symptom Manage 2013;45:1061–72.
. Robbins NM, Chaiklang K, Supparatpinyo K. Better antiretroviral central nervous system penetration is not associated with reduced chronic pain
in people living with human immunodeficiency virus. Antiinfect Agents 2016;14:38–46.
. Rosenfeld B, Breitbart W, McDonald MV, Passik SD, Thaler H, Portenoy RK. Pain
in ambulatory AIDS patients. II: impact of pain
on psychological functioning and quality of life. PAIN
. Safo S, Blank AE, Cunningham C, Quinlivan EB, Lincoln T, Blackstock OJ. Pain
is associated with missed clinic visits among HIV
-positive women. AIDS Behav 2017;21:1782–90.
. Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, Burchell AN, Cohen M, Gebo KA, Gill MJ. Closing the gap: increases in life expectancy among treated HIV
-positive individuals in the United States and Canada. PLoS One 2013;8:e81355.
. Sandoval R, Roddey T, Giordano TP, Mitchell K, Kelley C. Pain
, sleep disturbances, and functional limitations in people living with HIV
/AIDS-associated distal sensory peripheral neuropathy. J Int Assoc Provid AIDS Care 2014;13:328–34.
. Saylor D, Nakigozi G, Nakasujja N, Robertson K, Gray RH, Wawer MJ, Sacktor N. Peripheral neuropathy in HIV
-infected and uninfected patients in Rakai, Uganda. Neurology 2017;89:485–91.
. Schifitto G, McDermott M, McArthur J, Marder K, Sacktor N, Epstein L, Kieburtz K. Incidence of and risk factors for HIV
-associated distal sensory polyneuropathy. Neurology 2002;58:1764–8.
. Schifitto G, McDermott M, McArthur J, Marder K, Sacktor N, McClernon D, Conant K, Cohen B, Epstein L, Kieburtz K. Markers of immune activation and viral load in HIV
-associated sensory neuropathy. Neurology 2005;64:842–8.
. Shacham E, Rosenburg N, Onen NF, Donovan MF, Overton ET. Persistent HIV
-related stigma among an outpatient US clinic population. Int J STD AIDS 2015;26:243–50.
. Sherr L, Nagra N, Kulubya G, Catalan J, Clucas C, Harding R. HIV
infection associated post-traumatic stress disorder and post-traumatic growth–a systematic review
. Psychol Health Med 2011;16:612–29.
. Silver NC, Dunlap WP. Averaging correlation coefficients: should Fisher's z transformation be used? J App Psychol 1987;72:146.
. Simmonds MJ, Novy D, Sandoval R. The differential influence of pain
and fatigue on physical performance and health status in ambulatory patients with human immunodeficiency virus. Clin J Pain
. Simms RW, Zerbini CAF, Ferrante N, Anthony J, Felson DT, Craven DE. Fibromyalgia syndrome in patients infected with human immunodeficiency virus. Am J Med 1992;92:368–74.
. Simpson DM, Rice AS, Emir B, Landen J, Semel D, Chew ML, Sporn J. A randomized, double-blind, placebo-controlled trial and open-label extension study to evaluate the efficacy and safety of pregabalin in the treatment of neuropathic pain
associated with human immunodeficiency virus neuropathy. PAIN
. Singer EJ, Kim J, Fahy-Chandon B, Datt A, Tourtellotte W. Headache in ambulatory HIV
-1-infected men enrolled in a longitudinal study. Neurology 1996;47:487–94.
. Singer EJ, Zorilla C, Fahy-Chandon B, Chi S, Syndulko K, Tourtellotte WW. Painful symptoms reported by ambulatory HIV
-infected men in a longitudinal study. PAIN
. Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain
inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev 2004;8:119–32.
. Smith MY, Egert J, Winkel G, Jacobsen J. The impact of PTSD on pain
experience in persons with HIV
. Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review
of interventions to reduce HIV
-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc 2013;16:18374.
. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, Carpenter J, Rücker G, Harbord RM, Schmid CH. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011;343:d4002.
. Surratt HL, Kurtz SP, Levi-Minzi MA, Cicero TJ, Tsuyuki K, O'Grady CL. Pain
treatment and antiretroviral medication adherence among vulnerable HIV
-positive patients. AIDS Patient Care STDS 2015;29:186–92.
. Teti M, Bowleg L, Lloyd L. “Pain
on top of pain
, hurtness on top of hurtness”: social discrimination, psychological well-being, and sexual risk among women living with HIV
/AIDS. Int J Sex Health 2010;22:205–18.
. Thompson MA, Mugavero MJ, Amico KR, Cargill VA, Chang LW, Gross R, Orrell C, Altice FL, Bangsberg DR, Bartlett JG. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV
: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med 2012;156:817–33.
. Trafton JA, Sorrell JT, Holodniy M, Pierson H, Link P, Combs A, Israelski D. Outcomes associated with a cognitive-behavioral chronic pain
management program implemented in three public HIV
primary care clinics. J Behav Health Serv Res 2012;39:158–73.
. Tsui JI, Cheng DM, Coleman SM, Blokhina E, Bridden C, Krupitsky E, Samet JH. Pain
is associated with heroin use over time in HIV
-infected Russian drinkers. Addiction 2013;108:1779–87.
. Tsui JI, Cheng DM, Coleman SM, Lira MC, Blokhina E, Bridden C, Krupitsky E, Samet JH. Pain
is associated with risky drinking over time among HIV
-infected persons in St. Petersburg, Russia. Drug Alcohol Depend 2014;144:87–92.
. Tsui JI, Cheng DM, Libman H, Bridden C, Samet J. Hepatitis C virus infection is associated with painful symptoms in HIV
-infected adults. AIDS Care 2012;24:820–7.
. Tsui JI, Cheng DM, Quinn E, Bridden C, Merlin JS, Saitz R, Samet JH. Pain
and mortality risk in a cohort of HIV
-infected persons with alcohol use disorders. AIDS Behav 2016;20:583–9.
. Uebelacker LA, Weisberg RB, Herman DS, Bailey GL, Pinkston-Camp MM, Garnaat SL, Stein MD. Pilot randomized trial of collaborative behavioral treatment for chronic pain
and depression in persons living with HIV
/AIDS. AIDS Behav 2016;20:1675–81.
. Uebelacker LA, Weisberg RB, Herman DS, Bailey GL, Pinkston-Camp MM, Stein MD. Chronic pain
-infected patients: relationship to depression, substance use, and mental health and pain
. van Sighem A, Gras L, Reiss P, Brinkman K, de Wolf F. Life expectancy of recently diagnosed asymptomatic HIV
-infected patients approaches that of uninfected individuals. AIDS 2010;24:1527–35.
. Wadley AL, Mitchell D, Kamerman PR. Resilience does not explain the dissociation between chronic pain
and physical activity in South Africans living with HIV
. PeerJ 2016;4:e2464.
. Wadley AL, Pincus T, Evangeli M. A preliminary analysis of the association between perceived stigma and HIV
. Unpublished. Accessed September 27, 2017. doi: .
. Ware NC, Wyatt MA, Tugenberg T. Social relationships, stigma and adherence to antiretroviral therapy for HIV
/AIDS. AIDS Care 2006;18:904–10.
. Williams A, Eccleston C, Morley S. Psychological therapies for the management of chronic pain
(excluding headache) in adults. Cochrane Database Syst Rev 2012;11:CD007407.
. Williams ACdC. Defeating the stigma of chronic pain
. Williams ACdC. What can evolutionary theory tell us about chronic pain
. Williams ACdC, Craig KD. Updating the definition of pain
. Wittchen HU, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier D. Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The multicentre WHO/ADAMHA field trials. Br J Psychiatry 1991;159:645–53.
. Woldeamanuel YW, Kamerman PR, Veliotes DG, Phillips TJ, Asboe D, Boffito M, Rice AS. Development, validation, and field-testing of an instrument for clinical assessment of HIV
-associated neuropathy and neuropathic pain
in resource-restricted and large population study settings. PLoS One 2016;11:e0164994.
. Zelman DC, Dukes E, Brandenburg N, Bostrom A, Gore M. Identification of cut-points for mild, moderate and severe pain
due to diabetic peripheral neuropathy. PAIN
. Zukoski AP, Thorburn S. Experiences of stigma and discrimination among adults living with HIV
in a low HIV
-prevalence context: a qualitative analysis. AIDS Patient Care STDS 2009;23:267–76.