The goal of this analysis was to report the prevalence of pain and identify correlates of pain among PLHIV. A total of 733 PLHIV enrolled in the Florida Cohort Study completed the study assessments (Table 1). Roughly half (45.0%) of our sample reported pain in the previous 24 hours. Additionally, 118 (16.1%) participants reported severe pain in the previous 24 hours. Overall, 426 (58.1%) participants were aged between 18 and 49, and 307 (41.9%) were in the age group of 50 years and older. Furthermore, 500 (68.2%) of participants were men and 233 (31.8%) were women. Among the participants who completed the demographic assessment, 403 (57.3%) were black and roughly 73.8% were unemployed.
Table 1. Demographic Mental Health and Substance Use Characteristics of Any Current Pain Among PLHIV N=733
|
Characteristics
|
No Pain
N = 403 (56.0%)
|
Any Pain
N = 330 (45.0%)
|
Unadjusted Odds Ratio
|
P Value
|
Age in Years
|
|
|
|
< 0.01
|
18-49 (n=426)
|
255 (59.9)
|
171 (40.1)
|
ref
|
|
≥50 (n=307)
|
148 (48.2)
|
159 (51.8)
|
1.60 (1.19, 2.15)
|
|
Sex
|
|
|
|
0.11
|
Male (n=500)
|
285 (57.0)
|
215 (43.0)
|
ref
|
|
Female (n=233)
|
118 (50.6)
|
115 (49.4)
|
1.29 (0.95,1.77)
|
|
Race/ethnicity
|
|
|
|
0.15
|
Non-Hispanic Black (n=403)
|
222 (55.1)
|
181 (44.9)
|
ref
|
|
Non-Hispanic White (n=157)
|
77 (49.0)
|
80 (51.0)
|
0.81 (0.55, 1.20)
|
|
Hispanic (n=143)
|
86 (60.1)
|
57 (39.9)
|
1.27 (0.88, 1.84)
|
|
Employment
|
|
|
|
< 0.01
|
Employed (n=188)
|
128 (68.1)
|
60 (31.9)
|
ref
|
|
Unemployed (n=529)
|
266 (50.3)
|
263 (49.7)
|
2.11 (1.49, 3.00)
|
|
Anxiety (GAD-7)
|
|
|
|
< 0.01
|
No (<10) (n=493)
|
315 (63.9)
|
178 (36.1)
|
ref
|
|
Yes (≥10) (n=219)
|
79 (36.1)
|
140 (63.9)
|
3.14 (2.25, 4.37)
|
|
Depression (PHQ-8)
|
|
|
|
< 0.01
|
No (<10) (n=492)
|
308 (62.6)
|
184 (37.4)
|
ref
|
|
Yes (≥10) (n=229)
|
93 (40.6)
|
136 (59.4)
|
2.45 (1.78, 3.37)
|
|
Post-Traumatic Stress Disorder (PC-PTSD)
|
|
|
|
< 0.01
|
No (n=511)
|
315 (61.6)
|
196 (38.4)
|
ref
|
|
Yes (n=202)
|
76 (37.6)
|
126 (62.4)
|
2.66 (1.90, 3.73)
|
|
Marijuana Use
|
|
|
|
0.03
|
No (n=466)
|
266 (57.1)
|
200 (42.9)
|
ref
|
|
Recreational use (n=147)
|
83 (56.5)
|
64 (43.5)
|
1.03 (0.71, 1.49)
|
|
Therapeutic use (n=104)
|
45 (43.3)
|
59 (56.7)
|
1.74 (1.14, 2.68)
|
|
Alcohol Consumption
|
|
0.47
|
No Drinking (n=192)
|
112 (58.3)
|
80 (41.7)
|
ref
|
|
Non-Hazardous Drinking (n=257)
|
140 (54.5)
|
117 (45.5)
|
1.17 (0.80, 1.71)
|
|
Hazardous Drinking (n=255)
|
134 (52.6)
|
121 (47.5)
|
1.26 (0.87, 1.85)
|
|
Lifetime Injection drug use
|
|
|
|
0.09
|
No (n=611)
|
346 (56.6)
|
265 (43.4)
|
ref
|
|
Yes (n=101)
|
48 (47.5)
|
53 (52.5)
|
1.44 (0.95, 2.20)
|
|
Lifetime Crack/Cocaine
|
|
|
|
0.86
|
No (n=625)
|
340 (54.7)
|
281 (42.3)
|
Ref
|
|
Yes (n=102)
|
54 (53.5)
|
47 (46.5)
|
1.05 (0.69, 1.61)
|
|
Mental Health Factors and Any Current Pain
Differences in mental health symptoms between participants without any current pain and any pain are summarized in Table 1. Among PLHIV reporting any current pain, 63.9% experienced current symptoms of anxiety as compared to 36.1% who did not report current anxiety (p<0.01). Also, among PLHIV experiencing any current pain, 59.4% reported current symptoms of depression compared to 37.4% that did not (p<0.01). Likewise, 62.4% of PLHIV with current pain reported symptoms of PTSD while 38.4% did not report symptoms of PTSD (p<0.01).
Mental Health Factors and Severe Pain
Differences in mental health factors associated with severe pain are summarized in Table 3. Among PLHIV reporting severe pain, 27.4% experienced current symptoms of anxiety as compared to 10.5% that did not (p<0.01). Among participants reporting severe pain, 26.6%, reported current symptoms of depression compared to 10.8% of that did not (p<0.01). Similarly, 27.2% of participants with severe pain reported symptoms of PTSD compared to 11.5% that did not (p<0.01).
Table 3. Demographic Mental Health and Substance Use Characteristics of Severe Pain Among PLHIV N=733
|
Characteristics
|
Non-Severe Pain
N = 615 (83.9%)
|
Severe Pain
N = 118 (16.1%)
|
Unadjusted Odds Ratio
|
P Value
|
Age in Years
|
|
|
|
0.03
|
18-49 (n=426)
|
368 (86.4)
|
58 (13.6)
|
ref
|
|
≥50 (n=307)
|
247 (80.6)
|
60 (19.5)
|
1.54 (1.04, 2.29)
|
|
Sex
|
|
|
|
<0.01
|
Male (n=500)
|
435 (87.0)
|
65 (13.0)
|
ref
|
|
Female (n=233)
|
180 (77.3)
|
53 (22.6)
|
1.97 (1.32, 2.95)
|
|
Race/ethnicity
|
|
|
|
<0.01
|
Non-Hispanic Black (n=403)
|
324 (80.4)
|
79 (19.6)
|
ref
|
|
Non-Hispanic White (n=157)
|
139 (88.5)
|
18 (11.5)
|
0.53 (0.31, 0.92)
|
|
Hispanic (n=143)
|
128 (21.7)
|
15 (13.4)
|
0.48 (0.27, 0.87)
|
|
Employment
|
|
|
|
<0.01
|
Employed (n=188)
|
174 (92.6)
|
14 (7.4)
|
ref
|
|
Unemployed (n=529)
|
427 (80.7)
|
102 (19.3)
|
2.97 (1.65, 5.33)
|
|
Anxiety (GAD-7)
|
|
|
|
<0.01
|
No (<10) (n=493)
|
441 (89.5)
|
52 (10.5)
|
ref
|
|
Yes (≥10) (n=219)
|
159 (72.6)
|
60 (27.4)
|
3.20 (2.12, 4.83)
|
|
Depression (PHQ-8)
|
|
|
|
<0.01
|
No (<10) (n=492)
|
439 (89.2)
|
53 (10.8)
|
Ref
|
|
Yes (≥10) (n=229)
|
168 (73.4)
|
61 (26.6)
|
3.01 (2.00, 4.53)
|
|
Post-Traumatic Stress Disorder (PC-PTSD)
|
|
|
|
<0.01
|
No (n=511)
|
452 (88.5)
|
59 (11.5)
|
ref
|
|
Yes (n=202)
|
147 (72.8)
|
55 (27.2)
|
2.87 (1.90, 4.73)
|
|
Marijuana Use
|
|
|
|
0.10
|
No (n=466)
|
400 (85.8)
|
66 (14.2)
|
ref
|
|
Recreational use (n=147)
|
122 (83.0)
|
25 (17.0)
|
1.24 (0.75, 2.05)
|
|
Therapeutic use (n=104)
|
81 (77.9)
|
23 (22.1)
|
1.72 (1.01, 2.93)
|
|
Alcohol Consumption
|
|
0.31
|
No Drinking (n=192)
|
165 (85.9)
|
27 (14.1)
|
ref
|
|
Non-Hazardous Drinking (n=257)
|
219 (85.2)
|
38 (14.8)
|
1.06 (0.62, 1.81)
|
|
Hazardous Drinking (n=255)
|
207 (81.2)
|
48 (18.8)
|
1.42 (0.85, 2.37)
|
|
Lifetime Injection drug use
|
|
|
|
0.62
|
No (n=611)
|
514 (84.1)
|
97 (15.9)
|
ref
|
|
Yes (n=101)
|
83 (82.2)
|
18 (17.8)
|
1.15 (0.66, 2.00)
|
|
Lifetime Crack/Cocaine
|
|
|
|
|
No (n=625)
|
524 (83.8)
|
101 (16.2)
|
Ref
|
0.90
|
Yes (n=101)
|
85 (83.3)
|
17 (16.7)
|
1.04 (0.59, 1.82)
|
|
Substance Use Factors and Any Current Pain
Additionally, substance use factors associated with any current pain among PLHIV are summarized in Table 1. Of those PLHIV who reported any current pain, 56.7% used marijuana for therapeutic reasons, 43.5% used marijuana for recreational reasons, and 42.9% did not currently use marijuana (p=0.01). Substances including hazardous drinking, lifetime injection drug use, and lifetime crack/cocaine use were not statistically associated with any current pain at the bivariate level.
Substance Use Factors and Severe Pain
Substance use factors associated with severe pain among PLHIV are summarized in Table 3. Among PLHIV reporting severe pain, 22.1% used marijuana for therapeutic reasons, 17.0% used marijuana for recreational reasons, and 14.2% did not currently use marijuana (p=0.04). Substances including hazardous drinking, lifetime injection drug use, and lifetime crack/cocaine use were not statistically associated with severe pain at the bivariate level.
Sociodemographic Factors and Any Pain
Those PLHIV reporting pain were more likely to be age 50 years or older (51.8%) compared to PLHIV between 18-49 years old (40.1%) (p<0.01). PLHIV reporting being unemployed (49.7%) were also more likely to report having pain compared to employed individuals (31.9%) (p<0.0001). Additionally, female participants (49.4%) and non-Hispanic White PLHIV (51.0%) reported greater proportions of pain than their male and non-Hispanic Black counterparts respectively. However, race/ethnicity was not statistically significant at the bivariate level.
Sociodemographic Factors and Severe Pain
Those PLHIV reporting severe pain were more likely to be aged 50 years or older (19.5%) compared to PLHIV between ages year old 18-49 (13.6%) (p<0.01). Additionally, 19.6% of non-Hispanic Black participants reported severe pain compared to 13.5% of Hispanic and 11.5% of non-Hispanic White participants (p<0.01).Female participants (22.6%) were more likely to report severe pain compared to male participants (13.0%) (p<0.01).Unemployed PLHIV (19.3%) were also more likely to report having severe pain compared to employed PLHIV (7.4%) (p<0.01).
Any Current Pain vs. No Pain
Results of the adjusted odds ratios for the association of selected mental health, substance use, and sociodemographic factors with any pain are presented in Table 2. Any current pain was significantly more common in participants ≥50 years of age (AOR=1.73; CI 95% 1.23, 2.45, p <0.01), females (AOR= 1.47; CI 95% 1.01, 2.12, p=0.04), and unemployed participants (AOR=1.63; CI 95%1.08, 2.45, p=0.02) than PLHIV without those sociodemographic factors. Additionally, any current pain was significantly more common among PLHIV with symptoms of anxiety (AOR=2.49; CI 95% 1.48, 4.18, p <0.01) or PTSD (AOR=1.69; CI 95% 1.11, 2.57, p=0.02) compared to PLHIV without those factors. Factors including race/ethnicity, marijuana use, and depression were not significantly associated with any current pain.
Table 2. Multivariate Analysis of Selected Covariates of Any Current Pain vs No Pain Among PLHIV N=733
|
Predictor
|
Any Pain vs. No pain
|
P value
|
|
Adjusted OR1
|
95% CI2
|
|
Age in Years
|
|
|
18-49
|
|
Referent
|
|
|
≥50
|
1.73
|
1.23
|
2.45
|
<0.01
|
Sex
|
|
|
Male
|
|
Referent
|
|
|
Female
|
1.47
|
1.01
|
2.12
|
0.04
|
Race/Ethnicity
|
|
|
|
|
Non-Hispanic Black
|
|
Referent
|
|
|
Non-Hispanic White
|
1.40
|
0.93
|
2.11
|
0.11
|
Hispanic
|
0.82
|
0.52
|
1.30
|
0.37
|
Employment
|
|
|
Employed
|
|
Referent
|
|
|
Unemployed
|
1.63
|
1.08
|
2.45
|
0.02
|
Anxiety (GAD-7)
|
|
|
No (<10)
|
|
Referent
|
|
|
Yes (≥10)
|
2.49
|
1.48
|
4.18
|
<0.01
|
Depression (PHQ-8)
|
|
|
No
|
|
Referent
|
|
|
Yes
|
0.95
|
0.57
|
1.59
|
0.86
|
Post-Traumatic Stress Disorder (PC-PTSD)
|
|
|
No
|
|
Referent
|
|
|
Yes
|
1.69
|
1.11
|
2.57
|
0.01
|
Marijuana Use
|
|
|
No use
|
|
Referent
|
|
|
Recreational use
|
1.07
|
0.70
|
1.65
|
0.74
|
Therapeutic use
|
1.55
|
0.95
|
2.53
|
0.08
|
1OR – Odds Ratio
2CI – Confidence Interval
Severe Pain vs Non-Severe Pain
Results of the adjusted odds ratio of selected factors associated with severe pain are presented in Table 4. Pain was significantly more common in persons ≥ 50 years of age (AOR=1.70; CI 95% 1.07, 2.72, p= 0.03), females (AOR=2.02; CI 95% 1.26, 3.24, p <0.01), and participants reporting current symptoms of anxiety (AOR=2.03; CI 95% 1.03, 4.01, p= 0.04) compared to individuals without those factors. On the contrary, pain was protective among Hispanic participants (AOR=0.48; CI 95% 0.24, 0.96, p=0.04) compared to non-Hispanic Black participants. Factors including marijuana use, employment, depression, and PTSD were not statistically associated with severe pain.
Table 4. Multivariate Analysis of Selected Covariates of Severe Pain Among PLHIV N=733
|
Predictor
|
Non-Severe Pain vs Severe Pain
|
P Value
|
|
Adjusted OR1
|
95% CI2
|
|
Age in years
|
|
|
18-49
|
|
Referent
|
|
|
≥50
|
1.70
|
1.07
|
2.72
|
0.03
|
Sex
|
|
|
Male
|
|
|
|
|
Female
|
2.02
|
1.26
|
3.24
|
<0.01
|
Race/Ethnicity
|
|
|
Non-Hispanic Black
|
|
Referent
|
|
|
Non-Hispanic White
|
0.58
|
0.32
|
1.06
|
0.08
|
Hispanic
|
0.48
|
0.24
|
0.96
|
0.04
|
Employment
|
|
|
Employed
|
|
Referent
|
|
|
Unemployed
|
1.87
|
0.96
|
3.65
|
0.07
|
Anxiety (GAD-7)
|
|
|
No (<10)
|
|
Referent
|
|
|
Yes (≥10)
|
2.03
|
1.03
|
4.01
|
0.04
|
Depression (PHQ-8)
|
|
|
No
|
|
Referent
|
|
|
Yes
|
1.29
|
0.66
|
2.52
|
0.46
|
Post-Traumatic Stress Disorder (PC-PTSD)
|
|
|
No
|
|
Referent
|
|
|
Yes
|
1.58
|
0.93
|
2.70
|
0.10
|
Marijuana Use
|
|
|
No use
|
|
Referent
|
|
|
Recreational use
|
1.53
|
0.86
|
2.71
|
0.15
|
Therapeutic use
|
1.55
|
0.84
|
2.85
|
0.16
|
1OR – Odds Ratio
2CI – Confidence Interval