'Two Pains Together': Patient Perspectives on Psychological Aspects of Chronic Pain While Living with HIV

OBJECTIVE:

Chronic pain is common in HIV-infected individuals. Understanding HIV-infected patients' chronic pain experience not just from a biological, but also from a psychological perspective, is a critical first step toward improving care for this population. Our objective was to explore HIV-infected patients' perspectives on psychological aspects of chronic pain using in-depth qualitative interviews.

METHODS:

Investigators engaged in an iterative process of independent and group coding until theme saturation was reached.

RESULTS:

Of the 25 patients with chronic pain interviewed, 20 were male, 15 were younger than age 50, and 15 were African-American. Key themes that emerged included the close relationship between mood and pain; mood and pain in the context of living with HIV; use of alcohol/drugs to self-medicate for pain; and the challenge of receiving prescription pain medications while dealing with substance use disorders.

CONCLUSIONS:

The results suggest that psychological approaches to chronic pain treatment may be well received by HIV-infected patients.

...Use of alcohol/drugs to self-medicate for pain

A minority of participants reported that pain actually led them to use alcohol or drugs, in an attempt to alleviate their suffering. One participant described how in his case alcohol worked to help him manage his pain:

I would just drink [alcohol] it until my mind – it takes your mind differently. After you’ve had a few you get a good buzz going on and you don’t think about the pain no more. 34-year-old African-American male

Another participant explained how pain actually fueled the development of his addiction to illicit drugs:

Well, [pain and drug use] go hand in hand. Because when I hurt I wanna stop hurting so… and I know that… I know what will help me stop hurting…But and that’s the problem now is I use it when I’m not hurting…. It did go hand in hand for me but now it just became a, a problem or addiction.” 45-year-old African-American male

Most participants who discussed the role of illicit substances felt that self-medication in this way is only a temporary fix. After the drug has worn off, the person is left with their original pain:

You know, you know, drugs doesn’t help because uh if you try to alleviate the pain with – with drinkin’ alcohol ‘cause you gonna just – it’s gonna be a hurtin’ drunk. 52-year-old African-American male with severe chronic pain

For the few minutes that I’m using drugs, I don’t hurt…. And I might, uh, it might last, the pain might be gone for thirty minutes, hour…. But that’s only because cocaine done numb the feeling, I guess…But it, it always comes back which caused me to keep going get more cocaine 45-year-old African-American male

One participant felt that after getting off drugs his pain was even worse:

Uh actually … when I was doin’ the drugs [crack cocaine] I – I didn’t notice the pain. But now that I’m not I do feel – feel it a little more intensely. 48-year-old African American male...

Full article at:   http://goo.gl/2uCSXY

By:   Merlin JS¹, Walcott M², Ritchie C³, Herbey I², Kertesz SG⁴, Chamot E⁵, Saag M², Turan JM⁵.

¹Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

²Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

³Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California, United States of America; Jewish Home of San Francisco Center for Research on Aging, San Francisco, California, United States of America.

⁴Birmingham VA Medical Center, Birmingham, Alabama, United States of America; Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

⁵School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

  

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