Chronic pain is common in
HIV, but incompletely characterized, including its underlying etiologies, its
effect on healthcare utilization, and the characteristics of affected patients
in the HIV primary care setting.
These data are needed in order to design and
justify appropriate clinic-based pain management services. Using a clinical
data warehouse, we analyzed one year of data from 638 patients receiving
standard-of-care antiretroviral therapy in a large primary care HIV clinic,
located in the Harlem neighborhood of New York City.
We found that 40% of
patients carried one or more chronic pain diagnoses. The most common diagnoses
were degenerative musculoskeletal disorders (e.g. degenerative spinal disease
and osteoarthritis), followed by neuropathic pain and headache disorders. Many
patients (16%) had multiple chronic pain diagnoses.
Women, older patients, and
patients with greater burdens of medical illness, and psychiatric and substance
use co-morbidities were disproportionately represented among those with chronic
pain diagnoses. Controlling for overall health status, HIV patients with
chronic pain had greater healthcare utilization including emergency department
visits and radiology procedures.
In summary, our study demonstrates the high
prevalence of chronic pain disorders in the primary care HIV clinic. Co-located
interventions for chronic pain in this setting should focus on musculoskeletal
pain but also account for complex multifaceted pain syndromes, and address the
unique biopsychosocial features of this population.
Furthermore since chronic
pain is prevalent in HIV and associated with increased healthcare utilization,
developing clinic-based pain management programs could be cost-effective.
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By:
- 1Icahn School of Medicine at Mount Sinai, Department of Neurology
- Icahn School of Medicine at Mount Sinai, Mount Sinai Data Warehouse.
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