Abstract #194  -  Title: the prevalence and psychological management of chronic pain in people living with HIV.
Authors:   Presenting Author:   Dr Sharon Kalsy - The Hillingdon Hospital
Additional Authors:  Dr  Sharon Kalsy,
Aim: 1. To investigate the prevalence of chronic pain symptoms in people living with HIV (PLWH), including cognitive and coping constructs 2. To evaluate the effectiveness of a Pain Management Program on patients experiencing chronic pain.
Method / Issue: 1. A cross-sectional sample of patients attending an out-patient HIV service in the UK completed a range of self-report questionnaires that examined the experience of pain and the impact of disability and mood on coping. The measures included: The Pain Catastrophising Scale The Pain Self-Efficacy Scale The Hospital Anxiety and Depression Scale Owestry Disability Index 2. A group-based pain management program was offered to PLWH who reported pain. The group comprised an eight week programme, which involved sessions facilitated by a Clinical Psychologist, an Occupational Therapist and a Physiotherapist. Pre, post and 4 week outcome measures were completed to assess the effectiveness of the pain management program in reducing the impact of pain.
Results / Comments: Results: 1. Cross-sectional survey: Collation of data is still continuing, however, preliminary results were obtained from N=27 (i.e. 10% of HIV cohort). Two thirds of the sample reported that pain symptoms affected activities of daily living. The relationship between intensity of pain and depression was approaching significance (r=0.057, p<0.1). No significant relationship was found between the extent of disability caused by pain and cognitive distortions, namely catastrophising, anxiety and depression. No significant relationship was found between intensity of pain and pain self-efficacy. Complete data of the larger sample size will be reported at the conference. 2. Pain Management Group: High levels of satisfaction with the intervention were found. Improvements in pain symptoms were sustained at one month follow up. A positive correlation was found between pain symptoms and self-efficacy (r=0.025, p<0.05) and depression ((r=0.05, p<0.05). Levels of coping with pain improved significantly pre- and post-group [t(0.04), p<0.05)] and at pre-group and one month follow-up [t(0.007), p<0.05)]. Pain intensity improved significantly at pre- and post-group [t(0.03), p<0.05)], but not at one month follow-up. Depression scores decreased significantly between pre- and post-group [t(0.04), p<0.05)].
Discussion: A high prevalence of chronic pain was found in the study. However, this is often under-reported by patients and underestimated by clinical staff (Larue, Fontaine & Colleau, 1997). Whilst there is literature that exists to suggest that chronic pain can have a significant impact on the psychological well-being and quality of life of patients, there continues to be a dearth of current research relevant to PLWH. Pain management programmes have been shown to be effective in general health settings (Department of Health, 2000). This pilot study demonstrates the effectiveness of a pain management program for PLWH. The stigmatising nature of HIV and the considerable psychological adjustment required may affect how pain disorders are managed (Evans et al., 1998). The prevalence of pain is high among PLWH indicating that existing NHS pain management programmes can be offered to PLWH, with little modification and without cost implications. Date collation is continuing for the cross sectional survey and six month follow-up of the group. The implications of these results in terms of service developments and patient care will be presented at conference.
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