While many AIDS defining conditions are decreasing because of the development of effective antiretroviral therapies, peripheral neuropathy remains a significant problem because many nucleoside antiretrovirals may cause or exacerbate the condition. It has been established that neuropathic pain in ambulatory patients with HIV is prevalent and associated with significant psychological distress, social-vocational impairment, and diminished quality of life. Adjuvants or alternatives to analgesics are needed for reasons including: 1) analgesics alone are not always successful in treating pain, 2) patient's fears of side-effects, addiction, tolerance, and 3) clinician's concerns regarding use of analgesics for certain patients including those with dementia and delirium. The investigators seek to study the efficacy of a manualized cognitive-behavioral treatment (CBT) designed to target HIV-neuropathic pain and its related distressing symptoms. The investigators hypothesize that CBT, which provides specific guidelines for clinical practice, and offers health care providers tools for treating HIV pain sufferers, will prove to be significantly more effective than Supportive Psychotherapy (SP). Response to treatment will be assessed by measures of pain intensity, analgesic use, psychological distress, functional role, and quality of life. Over a 2 1/2 year period, 175 patients with moderate to severe pain will be recruited for this within subject 18-week study. A 6-week baseline monitoring period will control for possible variations in medical management and provide a yardstick against which to compare the efficacy of CBT vs. SP. Patients will be randomized at the of the baseline phase to receive six sessions of CBT or SP. A 6-week follow-up evaluation will be conducted to determine stability of effect over time. Throughout the study, patients will maintain a daily analgesic diary, recording changes in antiretrovirals or other medications and any medical treatments they receive for pain. A secondary aim is to determine the role of health locus of control as a mediator in treatment response.
| Davis, L; Evans, S; Fishman, B et al. (2004) Predictors of attrition in HIV-positive subjects with peripheral neuropathic pain. AIDS Care 16:395-402 |
| Evans, Susan; Weinberg, Beth A; Spielman, Lisa et al. (2003) Assessing negative thoughts in response to pain among people with HIV. Pain 105:239-45 |
