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UBC Theses and Dissertations

Chronic pain and pain management strategies among people living with HIV who use unregulated drugs in Canada Loh, Jane M.


Background: Although chronic pain is prevalent among people who use drugs (PWUD) and people living with HIV (PLWH), there have been few investigations of pain among PLWH who use drugs. To fill this gap, this thesis sought to evaluate the prevalence and correlates associated with chronic pain, analyze the associations of pain medication denial, and explore common pharmacologic and non-pharmacologic pain self-management strategies among PLWH who use drugs. Methods: Data were derived from the AIDS Care Cohort to Evaluate exposure to Survival Services (ACCESS) study, an open prospective cohort study of HIV-positive people who use drugs linked to comprehensive HIV clinical data. Generalized linear mixed-effects modelling (GLMM) was used to estimate the prevalence of and identify exposures linked to chronic pain (study 1) and to analyze associations of pain management strategies with substance use and socio-structural exposures (study 3). Generalized estimating equations (GEE) were used to explore the independent relationships between pain medication denial with various substance use, social-, and healthcare access measures (study 2). Results: In study 1, 374 (53%) participants reported recent moderate-to-extreme pain. Multivariable GLMM analysis revealed chronic pain was associated with pain self-management, non-fatal overdose, non-medical prescription opioid use, and mental illness. Being denied pain medication was reported by 84 (20%) participants in study 2. In a multivariable GEE model, recent pain medication denial was associated with recent incarceration, daily cocaine injection, pain self-management, attempted suicide, and not visiting a family physician. In study 3, pain self-management was reported by 342 (70%) participants; multivariable GLMM identified associations with homelessness, daily injection heroin and non-medical prescription opioid use, and being diagnosed with a chronic pain condition. Self-management strategies primarily involved illicit substances (66%), however, 34% indicated non-substance-based strategies. Conclusions: The findings of this research emphasize that chronic pain is often undertreated among PLWH who use drugs and frequently leads to use of higher-risk pain management alternatives and negative health outcomes. This research builds upon prior evidence calling for accessible, integrated care services that provide both pharmacologic and non-pharmacologic pain management strategies that may reduce the risks and consequences associated with being denied pain medication and self-managing pain.

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