Rutgers University College of Nursing, Newark, New Jersey 07102-1897, USA.
J Pain Symptom Manage. 2011 Feb;41(2):469-77. doi: 10.1016/j.jpainsymman.2010.05.011. Epub 2011 Jan 13.
Muscle aches, numbness in the feet/toes (neuropathy), and fatigue are often reported concurrently and are among the symptoms most frequently reported by individuals with HIV/AIDS, whether or not they are taking antiretroviral therapy (ART).
This study used a longitudinal analytical methodology to analyze these symptoms together to determine whether symptom clusters are maintained over time and to determine whether there is a temporal relationship between fatigue and reports of neuropathic pain and muscle aches.
This was a secondary analysis of a subset of data from a six-month, longitudinal, randomized, controlled trial of 243 HIV-positive individuals taking ART. Self-reported symptom frequency and intensity were recorded using the Revised Sign and Symptom Checklist for Persons with HIV disease at baseline (Month 0), one, three, and six months. Multilevel, logistic regression models were used to analyze time-lagged effects of muscle aches, numbness of the feet/toes, and fatigue to estimate any predictive and interactive effects that the symptoms have upon one another.
A significant relationship between muscle aches and fatigue intercepts was noted (odds ratio [OR]=1.80, P≤0.05). Significant relationships between numbness and fatigue also were noted for the entire measurement period (OR=2.70, P≤0.05). Time-lagged models showed persons reporting neuropathic-related numbness in one period were nearly twice as likely to report fatigue in subsequent periods (OR=1.89, P≤0.05). The final model revealed that the addition of muscle aches and numbness explained 28% of the random variance in the occurrence of fatigue. Between-person descriptive variables including years living with HIV, age, having an AIDS diagnosis, ethnicity, and nucleoside reverse transcriptase inhibitor treatment regimens with stavudine, zalactabine, or didanosine did not significantly explain any additional model variation.
These findings are consistent with physiological research and provide evidence that analyzing multiple symptom change over time can provide a more accurate representation of an individual's symptom experience. When evaluating patients with muscle aches or numbness, particularly when both symptoms are present, an evaluation of fatigue should be considered. Similarly, if fatigue is reported, underlying physiological assessments for neuropathic symptoms and muscle aches may be considered.
肌肉疼痛、脚/脚趾麻木（周围神经病变）和疲劳通常会同时出现，是艾滋病毒/艾滋病患者（无论是否接受抗逆转录病毒治疗 (ART)）报告的最常见症状之一。
本研究使用纵向分析方法来综合分析这些症状，以确定症状群是否随时间保持稳定，以及疲劳与报告的神经病理性疼痛和肌肉疼痛之间是否存在时间关系。
这是对接受 ART 的 243 名艾滋病毒阳性个体进行的为期六个月的纵向、随机、对照临床试验的一部分数据的二次分析。在基线（第 0 个月）、一个月、三个月和六个月时，使用修订后的 HIV 感染者症状和体征检查表记录自我报告的症状频率和强度。使用多级逻辑回归模型分析肌肉疼痛、脚/脚趾麻木和疲劳的时间滞后效应，以估计这些症状彼此之间的任何预测和交互影响。
注意到肌肉疼痛和疲劳截距之间存在显著关系（优势比 [OR]=1.80，P≤0.05）。在整个测量期间，麻木与疲劳之间也存在显著关系（OR=2.70，P≤0.05）。时间滞后模型显示，在一个时期报告与神经病变相关的麻木的人在随后的时期报告疲劳的可能性几乎是前者的两倍（OR=1.89，P≤0.05）。最终模型显示，肌肉疼痛和麻木的增加解释了疲劳发生的 28%的随机方差。包括感染艾滋病毒年限、年龄、艾滋病诊断、种族、以及包含司他夫定、扎西他滨或地达诺辛的核苷逆转录酶抑制剂治疗方案在内的个体间描述性变量并未显著解释任何额外的模型变化。
这些发现与生理研究一致，并提供了证据表明，分析多个症状随时间的变化可以更准确地反映个体的症状体验。在评估有肌肉疼痛或麻木的患者时，特别是当这两种症状同时存在时，应考虑疲劳评估。同样，如果报告疲劳，可能会考虑进行神经病理性症状和肌肉疼痛的潜在生理评估。
