Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy

J. Robinson-Papp, S. Morgello, F. Vaida, C. Fitzsimons, D. M. Simpson, K. J. Elliott, M. Al-Lozi, B. B. Gelman, D. Clifford, C. M. Marra, J. A. McCutchan, J. H. Atkinson, R. H. Dworkin, I. Grant, R. Ellis

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Sensory neuropathy (HIV-SN) is a common cause of pain in HIV-infected people. Establishing a diagnosis of HIV-SN is important, especially when contemplating opioid use in high-risk populations. However physical findings of HIV-SN may be subtle, and sensitive diagnostic tools require specialized expertise. We investigated the association between self-report of distal neuropathic pain and/or paresthesias (DNPP) and objective signs of HIV-SN. Data were obtained from the Central Nervous System HIV Antiretroviral Therapy Effects Research (CHARTER) study. Out of 237 participants, 101 (43%) reported DNPP. Signs of HIV-SN were measured by a modified Total Neuropathy Score (TNS), composed of six objective sensory subscores (pin sensibility, vibration sensibility, deep tendon reflexes, quantitative sensory testing for cooling and vibration, and sural sensory amplitude). Self-report of DNPP was associated with all six TNS items in univariate analysis and with four TNS items in multivariate analysis. The sensitivity and specificity of self-report of DNPP in detecting the presence of a sensory abnormality were 52% and 92%, respectively with a PPV of 96% and a NPV of 34%. Increasing intensity of pain measured on a visual analog scale was associated with increasing severity of sensory abnormality. In summary, our results suggest that HIV-infected patients reporting symptoms consistent with HIV-SN, such as tingling, pins and needles, or aching or stabbing pain in the distal lower extremities, usually have objective evidence of HIV-SN on neurologic examination or with neurophysiologic testing. This finding holds true regardless of demographic factors, depression or substance use history.

Original languageEnglish (US)
Pages (from-to)732-736
Number of pages5
JournalPain
Volume151
Issue number3
DOIs
StatePublished - Dec 2010

Keywords

  • HIV
  • Neuropathic pain
  • Sensory neuropathy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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    Robinson-Papp, J., Morgello, S., Vaida, F., Fitzsimons, C., Simpson, D. M., Elliott, K. J., Al-Lozi, M., Gelman, B. B., Clifford, D., Marra, C. M., McCutchan, J. A., Atkinson, J. H., Dworkin, R. H., Grant, I., & Ellis, R. (2010). Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy. Pain, 151(3), 732-736. https://doi.org/10.1016/j.pain.2010.08.045