title: Pain is independently associated with impaired physical function in HIV-infected patients.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-infected patients in the current treatment era can achieve normal life expectancies but experience a high degree of medical and psychiatric comorbidity. Impaired physical function and pain, often in the context of mood disorders and substance abuse, are common in HIV-infected patients. The objective of this study was to investigate the relationship of pain, a modifiable condition, to functional impairment in HIV-infected patients, independent of mood disorders and substance abuse.
  
  
  METHODS
  Participants in a prospective cohort of HIV-infected patients at the University of Alabama at Birmingham were included. Patient-reported outcome measures were used to cross-sectionally assess pain and physical function (EuroQOL), mood disorders (PHQ), and substance abuse (ASSIST). Univariate and multivariable models were built with pain as the principal independent variable of interest and three domains of physical function (mobility, self-care, and usual activities) as outcomes. Covariates included mood, substance abuse, age, race, sex, insurance status, HIV transmission risk factor, and CD4+ T-cell count.
  
  
  RESULTS
  Among 1,903 participants, 693 (37%) reported pain; 509 (27%) had a mood disorder; and 157 (8.4%) reported current substance abuse. In multivariable models, pain was independently associated with increased odds of impairment in all three domains of physical function investigated-mobility (aOR 10.5, 95% CI 7.6-14.6), self-care (aOR 4.1, 95% CI 2.2-7.4), and usual activities (aOR 5.4, 95% CI 4.0-7.4).
  
  
  CONCLUSIONS
  Pain was associated with substantially increased odds of impairment in physical function. Pain should be an important consideration in HIV primary care. Interventions to address pain and impaired physical function should be investigated.
authors.affiliation: Division of Infectious Diseases, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Merlin
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.forename: Eric
authors.initials: E
authors.lastname: Chamot
authors.forename: E Turner
authors.initials: ET
authors.lastname: Overton
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology / Q000209:etiology; D009043:Motor Activity; D010146:Pain / Q000453:epidemiology* / Q000209:etiology* / Q000523:psychology; D015995:Prevalence; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology
keywords: HIV; Mental Health; Pain; Physical Function; Substance Abuse