@article{4db46ba291ff48b9ac9aa3e599b5acbb,
title = "Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy",
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.",
keywords = "HIV, Neuropathic pain, Sensory neuropathy",
author = "J. Robinson-Papp and S. Morgello and F. Vaida and C. Fitzsimons and Simpson, {D. M.} and Elliott, {K. J.} and M. Al-Lozi and Gelman, {B. B.} and D. Clifford and Marra, {C. M.} and McCutchan, {J. A.} and Atkinson, {J. H.} and Dworkin, {R. H.} and I. Grant and R. Ellis",
note = "Funding Information: months research support from Arcion, Montel Williams Foundation, Philips Respironics, and Serono, and compensation for consulting from Acura, Allergan, Analgesic Solutions, Astellas, Boehringer Ingelheim, Cypress, Dainippon Sumitomo, DePuy, Durect, Eisai, Endo, Epicept, Flexion, Forest, Gilead, Gr{\"u}nenthal, Lilly, Michael J. Fox Foundation for Parkinson{\textquoteright}s Research, NeurogesX, Nuvo, PainReform, Pfizer, Sanofi Aventis, Sepracor, Smith and Nephew, Spinifex, UCB Pharma, US Department of Veterans Affairs, US Food and Drug Administration, US National Institutes of Health, Wyeth, and Xenon. J. Hampton Atkinson is a member of the Eli Lilly Scientific Advisory Board. David Clifford reports receiving research support from Bavarian Nordic, Biogen Idec, Boehringer Ingelheim, Gilead, GlaxoSmithKline, NeurogesX, Pfizer Inc., Schering Plough Corp., and Tibotec Pharmaceuticals and reports having been a consultant to Biogen Idec, Bristol-MeyersSquibb, Elan Corp., Forest Laboratories, Genentech, GenzymeCorp, GlaxoSmithKline, Millennium Pharmaceuticals Inc., Roche, and Schering Plough Corp. Robert H. Dworkin has received in the past 12 J. Allen McCutchan writes chapters for the Merck Manual. David Simpson receives financial compensation as a paid lecturer, and for his service on scientific advisory boards of several companies. These companies include Eli Lilly, NeurogesX, Cephalon, AstraZeneca, Pfizer, Endo Pharamceuticals, Meda Pharmaceuticals Inc., Alpharma and Allergan. The other authors have no conflicts to report. Funding Information: The CHARTER Study was supported by award N01 MH22005 from the National Institutes of Health . Dr. Robinson-Papp{\textquoteright}s work on the project described was supported by K23 NS066789 from the National Institute of Neurological Disorders And Stroke . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders And Stroke or the National Institutes of Health.",
year = "2010",
month = dec,
doi = "10.1016/j.pain.2010.08.045",
language = "English",
volume = "151",
pages = "732--736",
journal = "Pain",
issn = "0304-3959",
number = "3",
}