Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy.

TitleAssociation of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy.
Publication TypeJournal Article
Year of Publication2010
AuthorsRobinson-Papp, J, Morgello, S, Vaida, F, Fitzsimons, C, Simpson, DM, Elliott, KJ, Al-Lozi, M, Gelman, BB, Clifford, D, Marra, CM, McCutchan, JA, Atkinson, JH, Dworkin, RH, Grant, I, Ellis, R
Date Published2010 Dec
KeywordsAdult, CHARTER, Female, HIV Infections, Humans, Internal, Linear Models, Logistic Models, Male, Middle Aged, Neuralgia, Pain Measurement, Peripheral Nervous System Diseases, Polyneuropathies, Sensory Receptor Cells

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.

Alternate JournalPain
PubMed ID20851521
PubMed Central IDPMC2972365
Grant ListK23 NS066789 / NS / NINDS NIH HHS / United States
L60 MD002855 / MD / NIMHD NIH HHS / United States
K23 NS066789-01 / NS / NINDS NIH HHS / United States
K23 NS066789-02 / NS / NINDS NIH HHS / United States
N01 MH022005 / MH / NIMH NIH HHS / United States
L60 MD002855-02 / MD / NIMHD NIH HHS / United States