Silberman School of Social Work, Hunter College at City University of New York, 2180 Third Avenue, New York 10035, United States.
Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, United States.
Alcohol. 2019 Jun;77:31-39. doi: 10.1016/j.alcohol.2018.10.003. Epub 2018 Oct 9.
Adults 50 and older make up approximately 50% of persons living with HIV. Multiple co-morbidities are common among this group, including chronic pain and substance abuse, yet little is known about the daily factors that either enhance or inhibit these experiences or behaviors. This study explored daily drivers of substance use, pain, and relief from pain among older adults living with HIV utilizing ecological momentary assessment (EMA).
Participants (N = 55), ages 49-71, completed seven consecutive days of daily EMA online surveys prior to treatment initiation within a randomized controlled trial. Multilevel modeling tested predictors of pain, substance use, and relief from pain by examining within- and between-person relationships.
Results revealed an associational, reciprocal relationship between daily worst pain and daily drinking, where greater worst pain ratings predicted heavier drinking and heavier drinking predicted greater daily and overall pain. Greater happiness and poorer quality of sleep predicted greater daily worst pain. Exercising and overall confidence to cope with pain without medication were associated with lower levels of daily worst pain. Finally, spending less time with a loved one over time and reporting any coping behavior were associated with relief from pain.
Investigation of daily factors that drive pain and substance use behaviors among this unique population help inform which daily factors are most risky to their health and well-being. Alcohol use emerged as the only substance associated with both driving pain and responding to pain. Findings suggest key points for prevention and intervention.
50 岁及以上的成年人约占 HIV 感染者的 50%。这一人群中常同时存在多种合并症，包括慢性疼痛和药物滥用，但对于增强或抑制这些经历或行为的日常因素知之甚少。本研究利用生态瞬时评估（EMA）探讨了老年 HIV 感染者的药物使用、疼痛和疼痛缓解的日常驱动因素。
参与者（N=55）年龄在 49-71 岁之间，在一项随机对照试验开始治疗前完成了七天的连续日常 EMA 在线调查。多层模型通过检查个体内和个体间的关系，检验了疼痛、药物使用和疼痛缓解的预测因素。
结果显示，每日最严重疼痛和每日饮酒之间存在关联和相互关系，即更严重的最严重疼痛评分预示着饮酒量更大，而饮酒量更大则预示着每日和总体疼痛更大。幸福感和睡眠质量较差与每日最严重疼痛增加有关。锻炼和总体不依赖药物应对疼痛的信心与每日最严重疼痛水平较低有关。最后，随着时间的推移，与所爱的人相处的时间减少和报告任何应对行为与疼痛缓解有关。
对驱动这一独特人群疼痛和药物使用行为的日常因素的调查有助于了解哪些日常因素对他们的健康和福祉风险最大。酒精使用是唯一与疼痛驱动和疼痛反应都相关的物质。研究结果为预防和干预提供了重要依据。
