• Pain · Dec 2010

    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, and R Ellis.
    • Department of Neurology, Mount Sinai, School of Medicine, New York, NY 10029, USA. jessica.robinson-papp@mssm.edu
    • Pain. 2010 Dec 1; 151 (3): 732-6.

    AbstractSensory 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.Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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