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, Benjamin Gelman, D. Clifford, C. M. Marra, J. A. McCutchan, J. H. Atkinson, R. H. Dworkin, I. Grant, R. Ellis

Research output: Contribution to journalArticle

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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

Fingerprint

HIV
Paresthesia
Neuralgia
Self Report
Vibration
Pain
Stretch Reflex
Neurologic Examination
Visual Analog Scale
Opioid Analgesics
Needles
Lower Extremity
Multivariate Analysis
Central Nervous System
Demography
Depression
Sensitivity and Specificity
Research
Population

Keywords

  • HIV
  • Neuropathic pain
  • Sensory neuropathy

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • Neurology
  • Pharmacology

Cite this

Robinson-Papp, J., Morgello, S., Vaida, F., Fitzsimons, C., Simpson, D. M., Elliott, K. J., ... 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

Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy. / Robinson-Papp, J.; Morgello, S.; Vaida, F.; Fitzsimons, C.; Simpson, D. M.; Elliott, K. J.; Al-Lozi, M.; Gelman, Benjamin; Clifford, D.; Marra, C. M.; McCutchan, J. A.; Atkinson, J. H.; Dworkin, R. H.; Grant, I.; Ellis, R.

In: Pain, Vol. 151, No. 3, 12.2010, p. 732-736.

Research output: Contribution to journalArticle

Robinson-Papp, J, Morgello, S, Vaida, F, Fitzsimons, C, Simpson, DM, Elliott, KJ, Al-Lozi, M, Gelman, B, Clifford, D, Marra, CM, McCutchan, JA, Atkinson, JH, Dworkin, RH, Grant, I & Ellis, R 2010, 'Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy', Pain, vol. 151, no. 3, pp. 732-736. https://doi.org/10.1016/j.pain.2010.08.045
Robinson-Papp, J. ; Morgello, S. ; Vaida, F. ; Fitzsimons, C. ; Simpson, D. M. ; Elliott, K. J. ; Al-Lozi, M. ; Gelman, Benjamin ; Clifford, D. ; Marra, C. M. ; McCutchan, J. A. ; Atkinson, J. H. ; Dworkin, R. H. ; Grant, I. ; Ellis, R. / Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy. In: Pain. 2010 ; Vol. 151, No. 3. pp. 732-736.
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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.",
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AU - Elliott, K. J.

AU - Al-Lozi, M.

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AU - Clifford, D.

AU - Marra, C. M.

AU - McCutchan, J. A.

AU - Atkinson, J. H.

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AU - Grant, I.

AU - Ellis, R.

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