Prevalence of pain and association with psychiatric symptom severity in perinatally HIV-infected  children as compared to controls living in HIV-affected households.
This cross-sectional study evaluated the prevalence of pain and psychiatric symptoms in perinatally HIV-infected children at entry into P1055, a multicenter investigation of the prevalence and severity of psychiatric symptoms in HIV-infected children. Subjects 6-17 years of age and their primary caregivers were recruited from 29 International Maternal Pediatric Adolescent AIDS Clinical Trials sites in the USA and Puerto Rico. A total of 576 children (320 HIV and 256 HIV- children) were enrolled from June 2005 to September 2006. Subject self-reports of pain were measured by the Wong-Baker visual analog scale and Short-Form McGill Pain Questionnaire. Symptomatology for anxiety, depression, and dysthymia was assessed through Symptom Inventory instruments. Caregiver's assessment of their child's pain and psychiatric symptomatology was similarly measured. Logistic regression models were used to evaluate predictors of pain. We found that a higher proportion of HIV-infected than uninfected subjects reported pain in the last two months (41% vs 32%, p=0.04), last two weeks (28% vs 19%, p=0.02), and lasting more than one week (20% vs 11%, p=0.03). Among HIV-infected youth, females (OR=1.53, p=0.09), White race (OR=2.15, p=0.04), and Centers for Disease Control (CDC) Class C (OR=1.83, p=0.04) were significantly more likely to report pain. For all subjects, only 52% of caregivers recognized their child's pain and just 22% were aware that pain affected their child's daily activities. The odds of reported pain in HIV increased with higher symptom severity for generalized anxiety (OR=1.14, p=0.03), major depression (OR=1.15, p=0.03), and dysthymia (OR=1.18, p=0.01). This study underscores the importance of queries concerning pain and emotional stressors in the care of HIV and uninfected children exposed to HIV individuals. The discordance between patient and caregiver reports of pain and its impact on activities of daily living highlights that pain in children is under-recognized and therefore potentially under-treated.
Serchuck
Leslie K
LK
Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Shriver Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20892, USA.
Williams
Paige L
PL
Nachman
Sharon
S
Gadow
Kenneth D
KD
Chernoff
Miriam
M
Schwartz
Lynnae
L
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000523:psychology; D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D006679:HIV Seropositivity; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000523:psychology*; D010146:Pain / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D010147:Pain Measurement / Q000523:psychology*; D011647:Puerto Rico; D011788:Quality of Life; D012720:Severity of Illness Index; D014481:United States
J Pain. 2002 Oct;3(5):412-9
14622745
Acad Emerg Med. 2002 Jun;9(6):609-12
12045074
Pain. 2004 Oct;111(3):335-341
15363877
J Dev Behav Pediatr. 1994 Jun;15(3 Suppl):S18-25
7520454
Neurosignals. 2005;14(4):166-74
16215299
Pain. 1987 Aug;30(2):191-197
3670870
J Pediatr Psychol. 2003 Jan-Feb;28(1):29-39
12490628
Pediatr Emerg Care. 2002 Jun;18(3):159-62
12065998
Arthritis Care Res. 1996 Apr;9(2):89-96
8970266
Acta Paediatr. 2006 Aug;95(8):929-34
16882564
J Infect Dis. 2008 Dec 1;198(11):1599-608
19000014
Acta Paediatr. 2004 Jul;93(7):891-8
15303803
Curr Rev Pain. 2000;4(1):24-30
10998712
Clin J Pain. 2004 Mar-Apr;20(2):98-102
14770049
Pediatrics. 1999 May;103(5 Pt 1):975-9
10224175
Curr Pain Headache Rep. 2007 Apr;11(2):98-103
17367587
Pediatr Nurs. 1988 Jan-Feb;14(1):9-17
3344163
Pediatrics. 1996 Sep;98(3 Pt 1):449-52
8784372
J Pain Symptom Manage. 2007 Feb;33(2):208-16
17280926
J Dev Behav Pediatr. 1994 Jun;15(3 Suppl):S26-33
8063915
Clin J Pain. 1998 Dec;14(4):336-42
9874013
Arch Dis Child. 2002 May;86(5):325-9
11970920
Metabolism. 2005 May;54(5 Suppl 1):33-8
15877311
J Pediatr Psychol. 2006 Aug;31(7):674-83
16093515
Pediatr Infect Dis J. 2006 May;25(5):432-7
16645508
Pain. 2007 Mar;128(1-2):13-9
17055163
Pediatrics. 2001 Sep;108(3):E47
11533365
Pediatrics. 2002 Jun;109(6):1144-52
12042556
Pain. 2006 Aug;123(3):275-284
16644131