Prevalence of and factors associated with pain in ambulatory HIV and AIDS patients at the two teaching and referral Hospitals in Uganda.

Abstract

Background: Pain is a clinically significant problem contributing greatly to psychological and functional morbidity in HIV/AIDS patients. Limited research has been done on the magnitude, diversity and medical correlates of pain in HIV patients in developing countries. This underscores the need for increased clinical focus on identifying the presence of pain and adequate treatment of pain in all stages of HIV disease. This study aimed at estimating the prevalence of and factors associated with pain in the ambulatory HIV/AIDS patients. Methods: This was a cross-sectional study with both descriptive and analytic components employing quantitative methods of data collection. It was conducted at the AIDS outpatient clinics of Mulago and Mbarara Teaching and referral hospitals between January and May, 2008. Patients were selected using systematic sampling method and a total of 302 patients were recruited over the study period. Measurements included: Socio-demographics: age, gender, religion, education level, marital status, employment status, previous use of alcohol, drugs and smoking habits. Clinical: CD 4 count, viral load, WHO clinical disease stage, use of HAART, prevalence of symptoms, function performance, and previous treatment for pain. The dependent variables were presence/absence of pain and pain intensity. Measures : The Karnofsky Performance scale- measure of functional performance. The Brief pain Inventory (BPI) – for pain, Memorial Symptom Assessment Scale (MSAS)-intensity, frequency and distress associated with physical and psychological symptoms and the MOS HIV – for measuring Quality of Life. The inclusion criteria was all ambulatory HIV/AIDS patients aged 18 years and above attending AIDS outpatient clinics at the two study sites and consented to take part were in the study. Patients too ill to complete the questionnaires and those who could not comprehend English and or Luganda were excluded from the study. Data was analysed using STATA software: To determine whether socio-demographic variables are predictive of pain scores, socio-demographic groups were compared using ANOVA one way between groups using the F test. To establish the factors associated with presence of pain logistic regression analysis was used. Multiple regression analysis was used to determine the most parsimonious set of variables that predicted pain intensity Results: The mean age of the study population was 37 years and majority were female 64.24(n=194). Of the 302 patients recruited, 143 (47%) reported having had pain other than other than everyday kinds of pain like minor headaches, sprains and toothaches; one week prior to the study . Demographic variables were not associated with presence of or intensity of pain. 9+ number of symptoms reported was associated with 3 fold increase in the odds of pain as compared to 4-8 (OR = 3.3, CI (1.68-652), p = 0.001) . Physical symptom distress was also associated with a 4 fold increase in the odds of presence pain (OR = 3.6, CI 1.86-7.06, P<0.001). Single Marital status and physical symptom distress were associated with increasing pain intensity (beta = 1.31, P< 0.001, beta = 0.96, P = 0.023). Presence of pain was also associated with greater functional impairment t (df(300) =11.206, p <0.001) . Conclusions: Results demonstrate high levels of pain and pain related functional impairment among HIV and AIDS patients. The presence and intensity of pain are associated with demographic factors (single marital status) as well as a high symptom burden which may be a more proxy marker for disease progression.