title: Report of an HIV clinic-based pain management program and utilization of health status and health service by HIV patients.
abstract: BACKGROUND
  Current reports on human immunodeficiency virus (HIV) pain are limited to epidemiological data on neuropathic pain in HIV and most studies were conducted before the availability of highly active antiretroviral therapy. Complex pain was reported to be highly prevalent and associated with advanced disease.
  
  
  OBJECTIVE
  The authors conducted a retrospective review of the medical records of 81 patients from the Center for Positive Living (CPL) at Montefiore Medical Center who were newly referred to a pain management program in 2006 to identify the potential benefits of integrating a pain management team into the care of persons living with HIV and etiologies of pain.
  
  
  METHODS
  A standardized chart abstraction tool was used to capture clinical data. Data related to health service utilization and viral outcomes were obtained from the clinical information systems.
  
  
  RESULTS
  The most common pain diagnoses were multiple syndromes, degenerative disc disease or spinal stenosis, and neuropathy. There was a decrease in emergency room utilization in the 12 months following an initial pain management appointment (p < 0.0001) and an increase in use of primary care (p = 0.0017). The use of adjuvant medications increased after intake into the pain clinic (p < 0.0001). Having an opioid dose in excess of 200 mg/d oral morphine equivalents and maintenance of each palliative care and infectious disease clinic appointment were inversely associated with viral loads in excess of 75 copies: odds ratio (OR) = 0.21 (95% confidence interval/CI], 0.11-0.44), OR = 0.77 (95% CI, 0.68-0.86), and 0.94 (95% CI, 0.93-0.99), respectively.
  
  
  CONCLUSIONS
  The decrease in emergency room visits and increase in use of adjuvant analgesics and compliance with primary care and nonmedication approaches for the management of pain in the 12 months subsequent to initial palliative/pain clinic appointments highlight potential improved quality of care associated with the integration of a pain management team into the primary care of persons living with HIV disease.
authors.affiliation: Montgomery Hospital, Norristown, Pennsylvania, USA.
authors.forename: Ahashta
authors.initials: A
authors.lastname: Johnson
authors.forename: Kathleen DiGangi
authors.initials: KD
authors.lastname: Condon
authors.forename: Ann Celeste
authors.initials: AC
authors.lastname: Mapas-Dimaya
authors.forename: Judith
authors.initials: J
authors.lastname: Schrager
authors.forename: Robert
authors.initials: R
authors.lastname: Grossberg
authors.forename: Rosalyn
authors.initials: R
authors.lastname: Gonzalez
authors.forename: Sean
authors.initials: S
authors.lastname: O'Mahony
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009519:New York City; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000379:methods; D010166:Palliative Care / Q000379:methods; D010349:Patient Compliance; D011787:Quality of Health Care; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D000701:Analgesics, Opioid