Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy.
Sensory neuropathy (HIV-SN) is a common cause of pain in HIV-infected people. Establishing a diagnosis of HIV-SN is important, especially when contemplating opioid use in high-risk populations. However physical findings of HIV-SN may be subtle, and sensitive diagnostic tools require specialized expertise. We investigated the association between self-report of distal neuropathic pain and/or paresthesias (DNPP) and objective signs of HIV-SN. Data were obtained from the Central Nervous System HIV Antiretroviral Therapy Effects Research (CHARTER) study. Out of 237 participants, 101 (43%) reported DNPP. Signs of HIV-SN were measured by a modified Total Neuropathy Score (TNS), composed of six objective sensory subscores (pin sensibility, vibration sensibility, deep tendon reflexes, quantitative sensory testing for cooling and vibration, and sural sensory amplitude). Self-report of DNPP was associated with all six TNS items in univariate analysis and with four TNS items in multivariate analysis. The sensitivity and specificity of self-report of DNPP in detecting the presence of a sensory abnormality were 52% and 92%, respectively with a PPV of 96% and a NPV of 34%. Increasing intensity of pain measured on a visual analog scale was associated with increasing severity of sensory abnormality. In summary, our results suggest that HIV-infected patients reporting symptoms consistent with HIV-SN, such as tingling, pins and needles, or aching or stabbing pain in the distal lower extremities, usually have objective evidence of HIV-SN on neurologic examination or with neurophysiologic testing. This finding holds true regardless of demographic factors, depression or substance use history.
Robinson-Papp
J
J
Department of Neurology, Mount Sinai, School of Medicine, New York, NY, USA Department of Pathology, Mount Sinai School of Medicine, New York, NY, USA Department of Family and Preventative Medicine, University of California, San Diego, USA Department of Psychiatry, University of California, San Diego, USA Department of Neurology, Washington University, School of Medicine, St. Louis, MO, USA Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA Department of Neurology, University of Washington, Seattle, WA, USA Department of Medicine, University of California, San Diego, USA Department of Anesthesiology, University of Rochester, Rochester, NY, USA Department of Neurosciences, University of California, San Diego, USA.
Morgello
S
S
Vaida
F
F
Fitzsimons
C
C
Simpson
D M
DM
Elliott
K J
KJ
Al-Lozi
M
M
Gelman
B B
BB
Clifford
D
D
Marra
C M
CM
McCutchan
J A
JA
Atkinson
J H
JH
Dworkin
R H
RH
Grant
I
I
Ellis
R
R
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D010147:Pain Measurement; D010523:Peripheral Nervous System Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011115:Polyneuropathies / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011984:Sensory Receptor Cells