In men with HIV, daily social support may improve experiences of pain, and attachment style may influence the ways in which individuals leverage social support as a pain coping mechanism, according to a study published in Pain.

People living with HIV experience pain differently and disproportionately compared with the general population, but the mechanisms underlying these differences are poorly understood. Investigators examined factors that may play a role in pain modulation in men with HIV, including attachment styles and perceived social support.

A total of 109 men with HIV (mean age, 40.0 years; 54% black; 82% gay/bisexual) taking antiretroviral medication (mean exposure, 6.6 years) were included in the study. Moment-to-moment social support and pain experiences within persons were assessed 3 times daily over the course of 7 consecutive days, using an experience sampling method, web-based surveys, and attachment-related insecurity questionnaires. 

Attachment insecurity as it relates to social support and pain was also examined between persons, using the brief Experiences in Close Relationships tool to explore anxiety and avoidance. The short form of the Interpersonal Support Evaluation List was used to evaluate social support, and a numerical rating scale was used to assess pain intensity. Hierarchical linear modeling allowed us to examine the associations between these factors. Completion rates were 74% and 86% for experience sampling method surveys and questionnaires, respectively.

After adjusting for confounding factors (ie, age, race, sexual orientation, and socioeconomic status), social support was found to be associated with reduced subsequent pain within persons. Pain experiences were not found to be related to increased social support. Study participants with higher levels of attachment-related avoidance reported greater average pain intensities, and avoidance was found to moderate the relationship between perceived social support and pain intensity.

After controlling for current pain, avoidance was found to predict later increases in pain intensity (P =.015), and higher levels of attachment-related anxiety were associated with higher successive pain measures (P =.033). Attachment-related voidance was found to moderate the influence of perceived social support on later pain (P =.039).

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Study strengths included using an experience sampling method to evaluate moment-to-moment experiences of pain, which limited potential bias; the combination of experience sampling method with time-lagged analysis, which improved the understanding of the relationships between the studies’ variables and allowed inferences on directionality; and examination of cross-level interactions.

Study limitations included a small sample of men only, which might reduce generalizability to other populations; recruitment from a university HIV clinic that may not be representative of other treatment settings; participant noncompliance that resulted in missing data; and the use of brief measures that may limit overall understanding of the phenomena examined.

“These findings imply a need to assess social well-being at the clinic level and also support tailored biopsychosocial approaches to pain management in HIV care settings,” noted the authors, who recommended that larger trials explore social support sources and pain interventions in patients with HIV.

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Crockett KB, Turan B. Moment-to-moment changes in perceived social support and pain for men living with HIVPain. August 2018:1-25. doi:10.1097/j.pain.0000000000001354