title: Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV.
abstract: We investigated predictive and concurrent relationships among reported pain, HIV/AIDS illness burden, and substance use history in 2,267 participants in the longitudinal HIV Cost and Services Utilization Study (HCSUS). Substance use history was classified as screening positive for current illicit drug use (N=253), past drug use (N=617), and non-user (N=1,397) at baseline. To control for demographic correlates, age, sex and socioeconomic status (SES) were included as predictors. Covariance structure models indicated greater pain at baseline among participants acknowledging current substance use. Pain at baseline was also directly predicted by greater HIV/AIDS illness burden, lower SES, and older age. At 6 months, pain was directly predicted by prior pain, worse concurrent HIV/AIDS illness burden and female sex. At 12 months, pain was predicted by older age, prior pain, and concurrent HIV/AIDS illness. It was also modestly but significantly predicted by current substance use at baseline. In addition to the direct effects on pain, there were significant indirect effects of demographic and drug use variables on pain mediated through HIV/AIDS illness burden and prior pain. There were significant and positive indirect effects of current and past drug use, greater age, and lower SES on pain at all three time periods. Pain at 6 months and pain at 12 months were also indirectly impacted by previous illness burden. Our results indicate that HIV+persons who screened positive for current use of a range of illicit substances experienced greater HIV/AIDS illness burden which in turn predicted increased pain.
authors.affiliation: Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10940 Wilshire Blvd., Suite 1450, Los Angeles, CA 90024, USA Department of Health Services, VA Greater Los Angeles Healthcare System HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, UCLA School of Public Health, Los Angeles, CA, USA UCLA Department of Psychology, Los Angeles, CA, USA.
authors.forename: Jennie C I
authors.initials: JCI
authors.lastname: Tsao
authors.forename: Aram
authors.initials: A
authors.lastname: Dobalian
authors.forename: Judith A
authors.initials: JA
authors.lastname: Stein
mesh_terms: D000328:Adult; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D013287:Illicit Drugs