Pain management experiences in adults living with HIV/AIDS

Even though pain is common and often chronic in people living with HIV/AIDS (PLWHA), the management of pain is complicated and frequently woefully inadequate. Many factors influence the way PLWHA experience and communicate their pain. These factors can be categorized as both physiological and emotional. PLWHA often resort to self-care activities to control their pain because of the pervasive lack of adequate pain management by health care providers. The purposes of this study were to increase understanding of the pain management experiences in people living with HIV/AIDS (PLWHA) who report chronic pain and to elucidate the factors that influence this experience. Recruitment was conducted at 3 locations in Central Texas, USA; serving over 3,000 clients/year. A cross-sectional descriptive design and open-ended questions were used to explore PLWHA experiences in reporting chronic pain needs for at least 3 months and to describe pain management choices (self-care and/or seeking care activities) and communication with health care providers. Variables of interest were assessed with paper-pencil surveys (HIV-Self Efficacy Questionnaire, Coping Inventory for Pain in Persons Living with HIV/AIDS and Pain Self-Efficacy Questionnaire) and open-ended questions. Interviews ranged from 7-35 minutes each. One hundred PLWHA participated in the study, 53% African-American, 21% Hispanic and 25% Caucasian. They were primarily male (66%), 34% female, reported a mean age of 48 years and a mean of 13 years living with HIV. 83% of the participants rated their pain as consistently moderate to high levels; 82% rated they are likely to “tolerate the pain.” A majority of the participants (63%) reported they exercise or walk as a way of self-managing their pain. There was a significant association between use of pain management choices (self-care and/or seeking care activities) and confidence in performing life activities (r= 0.344, p<0.05). These findings indicate a need for health care providers to move beyond quantitative measures for this complex problem. Clinicians can use this information to understand the coping strategies used by PLWHA to manage pain. Future implications will be to develop appropriate pain management approaches (behavioral and pharmacological) for health care providers to improve control of chronic pain in PLWHA. Longitudinal studies are needed to explore the causative relationships between pain management choices (self-care and/or seeking care activities) and functional outcomes in PLWHA.