Greater Temporal Summation of Pain in HIV With Chronic Pain

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Individuals with HIV (with or without chronic pain) may lack conditioned pain modulation.
Individuals with HIV (with or without chronic pain) may lack conditioned pain modulation.

Individuals with HIV and chronic pain may have greater temporal summation of pain compared with healthy individuals or those with HIV but no chronic pain, according to a study published in the Journal of NeuroVirology. In addition, individuals with HIV (with or without chronic pain) may lack conditioned pain modulation.

Patients with HIV (n=59 with chronic pain; n=51 without chronic pain) who were attending a large urban clinic in the southeast United States and 50 individuals from the local community without HIV were enrolled in this study Quantitative sensory assessment for temporal summation of mechanical and heat pain and conditioned pain modulation were used to evaluate endogenous pain facilitatory and inhibitory processes, respectively.

Patients with HIV and chronic pain were found to have greater temporal summation of mechanical pain at the hand (P =.004) and trapezius (P =.011) compared with healthy controls and participants with HIV but no chronic pain. Patients with HIV and chronic pain also had greater temporal summation of heat pain at 46°C and 48°C compared with control individuals and those with HIV without chronic pain (P <.001 for both).

Symptoms of depression were associated with greater temporal summation of mechanical pain at the hand (P =.043), and pain catastrophizing was associated with greater temporal summation of heat pain at 48°C (P =.003) and temporal summation of mechanical pain at the hand (P =.043) and at the trapezius (P =.008). Healthy individuals had greater conditioned pain modulation effects at the forearm (P =.022) and trapezius (P =.046) compared with participants with HIV with or without chronic pain.

Study limitations include its cross-sectional nature and the reliance on self-reports to determine HIV status in control individuals.

 “[I]t will be important moving forward for clinically focused research and treatment to address the mental, as well as physical, health of [people living with HIV and] chronic pain.”

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Reference

Owens MA, Parker R, Rainey RL, et al. Enhanced facilitation and diminished inhibition characterizes the pronociceptive endogenous pain modulatory balance of persons living with HIV and chronic pain [published online November 9, 2018]. J Neurovirol. doi: 10.1007/s13365-018-0686-5

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