Sex differences in pain and misuse of prescription analgesics among persons with HIV

Abstract

Objective: Women represent the largest percentage of new HIV infections globally. Yet, no large-scale studies have examined the experience of pain and its treatment in women living with HIV.

Design: This study used structural equation modeling to examine sex differences in pain and the use and misuse of prescription analgesics in a representative sample of HIV+ persons in the United Stated within a prospective, longitudinal design.

Outcome measures: Bodily pain subscale of the Short-Form 36 and Modified Short Form of the World Health Organization's Composite International Diagnostic Interview (opioid misuse).

Results: Women reported more pain than men over a roughly 6-month period regardless of mode of HIV transmission or prior drug use history. Men acknowledged more misuse of prescription analgesics over an approximate 1-year period compared with women, after taking into account pain, use of analgesics specifically for pain, and drug use history. Weaker associations between pain and use of analgesics specifically for pain that persisted over time were found among women compared with men. For both men and women, pain was stable over time. Problem drug use history exerted significant direct and indirect effects on pain, opioid misuse, and pain-specific analgesic use across sex.

Conclusion: The current findings are consistent with prior evidence indicating female pain predominance as well as the undertreatment of pain among women with HIV. Efforts should be made to improve the assessment and long-term management of pain in HIV+ persons.

Figure 1

Longitudinal path model for female HCSUS participants (N = 664). Latent constructs are in circles, single items are in rectangles; 1-headed arrows depict standardized regression paths, 2-headed arrows represent correlations (standardized covariances). (^* = p ≤ .05, ^** = p ≤ .01, ^*** = p ≤ .001.)

Figure 2

Longitudinal path model for male HCSUS participants (N = 1603). Latent constructs are in circles, single items are in rectangles; 1-headed arrows depict standardized regression paths, 2-headed arrows represent correlations (standardized covariances). (^* = p ≤ .05, ^** = p ≤ .01, ^*** = p ≤ .001.)