Date Published:
2010 Dec

Publication Type:
Journal Article

Authors:

J. Robinson-Papp
S. Morgello
F. Vaida
C. Fitzsimons
D.M. Simpson
K.J. Elliott
M. Al-Lozi
B.B. Gelman
D. Clifford
C.M. Marra
J.A. McCutchan
J.H. Atkinson
R.H. Dworkin
I. Grant
R. Ellis

Secondary:
Pain

Volume:
151

Pagination:
732-6

Issue:
3

PMID:
20851521

URL:
https://pubmed.ncbi.nlm.nih.gov/20851521

DOI:
10.1016/j.pain.2010.08.045

Keywords:
Adult;CHARTER;Female;HIV Infections;Humans;Internal;Linear Models;Logistic Models;Male;Middle Aged;Neuralgia;Pain Measurement;Peripheral Nervous System Diseases;Polyneuropathies;Sensory Receptor Cells

Abstract:
<p>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.</p>