Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, England.
HIV i-Base, London, England.
AIDS Care. 2023 Aug;35(8):1164-1172. doi: 10.1080/09540121.2020.1869148. Epub 2021 Jan 14.
Pain is a highly prevalent and burdensome symptom among people with HIV (PWH). This study aims to identify how the experience of living with HIV and chronic pain influences pain beliefs, health-seeking and pain management. Thirty-nine purposively sampled PWH with chronic pain (sample characteristics = 61% women, 79% Black, Asian and minority ethnic groups, 18% men who have sex with men, 45-54 median age category) participated in focus groups in London. Focus groups were co-facilitated with community members. Transcripts wereanalysed using a thematic approach. Findings revealed that HIV stigma, fractured care pathways, and general practitioners' lack of HIV training are barriers to supported pain management. Unaddressed pain results in poorer mental health and reduced quality of life, which has important clinical implications for HIV treatment adherence. Creating HIV-specific pain resources, activating social networks, and pain self-management techniques are potential solutions. Person-centred assessment and HIV training is needed to help clinicians identify PWH with chronic pain. Clear guidelines need to be developed to identify which health service providers are responsible for chronic pain management in PWH. This study generated a refined version of the Fear Avoidance Model that introduces a dimension of HIV-specific behaviours that impact PWHs seeking chronic pain management.
HIV 感染者（PWH）普遍存在且负担沉重的症状是疼痛。本研究旨在确定 HIV 合并慢性疼痛患者的生活经历如何影响疼痛信念、求医行为和疼痛管理。39 名经有目的地抽样的 HIV 合并慢性疼痛的 PWH（样本特征为：61%为女性，79%为黑人、亚裔和少数族裔，18%为男男性行为者，45-54 岁为中位数年龄组）参加了在伦敦举行的焦点小组讨论。焦点小组由社区成员共同主持。使用主题方法分析转录本。研究结果表明，HIV 污名、破碎的护理途径以及全科医生缺乏 HIV 培训是支持疼痛管理的障碍。未得到解决的疼痛会导致更差的心理健康和降低生活质量，这对 HIV 治疗依从性具有重要的临床意义。创建特定于 HIV 的疼痛资源、激活社交网络和疼痛自我管理技术是潜在的解决方案。需要进行以人为本的评估和 HIV 培训，以帮助临床医生识别患有慢性疼痛的 PWH。需要制定明确的指南，以确定哪些卫生服务提供者负责 PWH 的慢性疼痛管理。本研究生成了恐惧回避模型的改良版本，该模型引入了影响寻求慢性疼痛管理的 PWH 的 HIV 特异性行为维度。
