All ETDs from UAB

Advisory Committee Chair

Burel Goodin

Advisory Committee Members

Jessica Merlin

Bulent Turan

Jarred Younger

Olivia Clay

Document Type

Dissertation

Date of Award

2020

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

Due to recent advancements in antiretroviral therapy (ART), people living with HIV (PLWH) who respond well and remain adherent to their medication regimens are achieving “near normal” life expectancies. As a result, HIV is no longer considered a death sentence, but rather a chronic health condition to be managed. However, the longer a person lives with the virus, the more prone to HIV-associated chronic diseases he or she becomes. One particularly important health condition with the potential to significantly and negatively impact quality of life is chronic pain. The prevalence rates of chronic pain in PLWH are estimated to be between 39 and 85%, higher than the 11 – 30% reported in the general (i.e., non-HIV) population. The chronic pain experienced by PLWH is often heterogeneous, including the classically described HIV neuropathy as well as widespread musculoskeletal pain. Although PLWH appear to be at a higher risk for developing chronic pain, the mechanisms underlying the chronification of pain in this population remain largely unknown. Current research suggests that development of chronic pain may be directly or indirectly related to HIV infection. HIV has been shown to cause significant inflammation, which can substantially exacerbate, if not cause, many types of chronic pain. Increased inflammation in PLWH has been shown to be a predictive factor in developing negative health outcomes. Although not yet specifically demonstrated in PLWH, heightened inflammation has been found to be predictive of poorer chronic pain outcomes. Additionally, psychosocial determinants are likely to play a role in chronic pain outcomes in PLWH as well. In addition to stigma related to their status, PLWH are at risk of experiencing intersectional stigma associated with life style factors and health conditions related to HIV, like chronic pain. Experienced and anticipated stigma may become internalized if PLWH begin to endorse negative feelings and beliefs about HIV and apply them to themselves. According to the stage model of self-stigma others’ stigmatizing behavior will be detrimental only when the stigmatized individual internalizes the stigmatizing thoughts and applies them to the self. Research has shown that intersectional stigma may interact and lead to poorer health outcomes than if individuals only experienced one source of stigma, or no stigma at all. This study aims to examine psychosocial factors affecting chronic pain including the role of intersectional HIV and chronic pain stigma in PLWH. Additionally, this study aims to examine the associations of basal and reactive pro-inflammatory cytokines (IL-6 and TNF-with clinical pain ratings and experimental pain sensitivity. Results showed that internalized chronic pain and HIV stigma individually and intersectionally predicted clinical pain severity, clinical pain interference, and pain catastrophizing in PLWH with chronic pain. However, no relationships were detected among measures of pain sensitivity. Further, there were no group differences detected between PLWH with and without chronic pain among measures of pain sensitivity. There was partial support for inflammation as a correlate of mechanical pain sensitivity. Interestingly, this study is one of the first to investigate both stigma and pain, clinically and experimentally. The results provide insights to how PLWH with chronic pain may share similarities or differ from other clinical populations, Specifically, stigma appears to be a crucial variable in cognitive-evaluative factors in PLWH with chronic pain. This may present an opportunity for clinical intervention via psychoeducation and psychological services. Further research addressing limitations continuing to examine inflammatory markers and pain sensitivity is warranted to follow-up partial support.

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