Psychosocial factors associated with persistent pain in people with HIV: a systematic review with meta-analysis

Abstract

Chronic pain remains a prevalent and disabling problem for people living with HIV in the current antiretroviral treatment era. Psychosocial treatments may have promise for managing the impact of this pain. However, research is needed to identify psychosocial processes to target through such treatments. The current systematic review and meta-analysis examined the evidence for psychosocial factors associated with pain, disability, and quality of life in people living with HIV and persistent pain. Observational and experimental studies reporting on the association between one or more psychosocial factors and one or more pain-related variables in an adult sample of people living with HIV and pain were eligible. Two reviewers independently conducted eligibility screening, data extraction, and quality assessment. Forty-six studies were included in the review and 37 of these provided data for meta-analyses (12,493 participants). "Some" or "moderate" evidence supported an association between pain outcomes in people with HIV and the following psychosocial factors: depression, psychological distress, posttraumatic stress, drug abuse, sleep disturbance, reduced antiretroviral adherence, health care use, missed HIV clinic visits, unemployment, and protective psychological factors. Surprisingly, few studies examined protective psychological factors or social processes, such as stigma. There were few high-quality studies. These findings can inform future research and psychosocial treatment development in this area. Greater theoretical and empirical focus is needed to examine the role of protective factors and social processes on pain outcomes in this context. The review protocol was registered with PROSPERO (CRD42016036329).

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Figure 2.

Forest plot of cross-sectional odds ratios (ORs) for depression. Depression was more likely in participants with vs without pain, as reflected in the pooled OR of >1. Gray boxes show weighting of individual studies; the red dotted line indicates the pooled effect around which effects from individual studies vary; the blue diamond shows the 95% CI around the pooled effect. CI, confidence interval.

Figure 3.

Forest plot of cross-sectional standardized mean differences (SMDs) for depression. Depression symptoms were more severe in participants with vs without pain, as indicated by a positive pooled SMD. CI, confidence interval.

Figure 4.

Forest plot of cross-sectional events data for psychological distress. Distress was more likely in participants with vs without pain, as reflected in the pooled odds ratio (OR) of >1. CI, confidence interval.

Figure 5.

Forest plot of cross-sectional standardized mean differences (SMDs) for psychological distress. Distress was more severe in participants with vs without pain, as reflected by a positive pooled SMD. CI, confidence interval.

Figure 6.

Forest plot of cross-sectional events data for drug abuse. Drug abuse was more likely in participants with vs without pain, as reflected in the pooled odds ratio (OR) of >1. CI, confidence interval.