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Pain is Independently Associated with Impaired Physical Function in HIV-Infected Patients

Authors

  • Jessica S. Merlin MD, MBA,

    Corresponding author
    1. Division of Infectious Diseases, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
    2. Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
    • Reprint requests to: Jessica S. Merlin, MD, MBA, University of Alabama at Birmingham, BBRB 222, 1530 3rd Avenue S, Birmingham, AL 35294-2170, USA. Tel: 215-806-1888; Fax: 205-934-5600; E-mail: jmerlin@uab.edu.

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  • Andrew O. Westfall MS,

    1. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • Eric Chamot MD, PhD,

    1. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • E. Turner Overton MD,

    1. Division of Infectious Diseases, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • James H. Willig MD, MSPH,

    1. Division of Infectious Diseases, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • Christine Ritchie MD, MSPH,

    1. Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California, USA
    2. Jewish Home of San Francisco Center for Research on Aging, San Francisco, California, USA
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  • Michael S. Saag MD,

    1. Division of Infectious Diseases, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • Michael J. Mugavero MD, MSPH

    1. Division of Infectious Diseases, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • Presented at: Infectious Diseases Society of America, San Diego, CA, October 2012; Association for Medical Education and Research in Substance Abuse, Bethesda, MD, November 2012; American Academy of Hospice and Palliative Medicine, New Orleans, LA, March 2013.
  • Conflicts of Interest and Support: JSM is supported by UL1 TR00165-05 and K12 HS019465-01. AOW received consulting fees from Definicare LLC. ETO has served as a consultant for ViiV Pharmaceuticals and Gilead Pharmaceuticals. He has received grant research support from Gilead Pharmaceuticals, Vertex Pharmaceuticals, Bristol Meyers Squibb, and Abbott Pharmaceuticals. JW has received grant support from Definicaire LLC. CSR is supported by 7K07AG031779 (NIA). MJM is supported by K23MH082641 and has received consulting fees (advisory board) from Merck Foundation, Bristol-Myers Squibb, and Gilead Sciences, and grant support to UAB from Tibotec Therapeutics, Pfizer, Inc, Bristol-Myers Squibb, and Definicare, LLC.

Abstract

Introduction

Human immunodeficiency virus (HIV)-infected patients in the current treatment era can achieve normal life expectancies but experience a high degree of medical and psychiatric comorbidity. Impaired physical function and pain, often in the context of mood disorders and substance abuse, are common in HIV-infected patients. The objective of this study was to investigate the relationship of pain, a modifiable condition, to functional impairment in HIV-infected patients, independent of mood disorders and substance abuse.

Methods

Participants in a prospective cohort of HIV-infected patients at the University of Alabama at Birmingham were included. Patient-reported outcome measures were used to cross-sectionally assess pain and physical function (EuroQOL), mood disorders (PHQ), and substance abuse (ASSIST). Univariate and multivariable models were built with pain as the principal independent variable of interest and three domains of physical function (mobility, self-care, and usual activities) as outcomes. Covariates included mood, substance abuse, age, race, sex, insurance status, HIV transmission risk factor, and CD4+ T-cell count.

Results

Among 1,903 participants, 693 (37%) reported pain; 509 (27%) had a mood disorder; and 157 (8.4%) reported current substance abuse. In multivariable models, pain was independently associated with increased odds of impairment in all three domains of physical function investigated—mobility (aOR 10.5, 95% CI 7.6–14.6), self-care (aOR 4.1, 95% CI 2.2–7.4), and usual activities (aOR 5.4, 95% CI 4.0–7.4).

Discussion

Pain was associated with substantially increased odds of impairment in physical function. Pain should be an important consideration in HIV primary care. Interventions to address pain and impaired physical function should be investigated.

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