PATIENT-RELATED BARRIERS TO PAIN MANAGEMENT IN AMBULATORY AIDS PATIENTS

A number of studies have demonstrated that pain is dramatically undert reated among patients with AIDS and that opioids in particular are rar ely prescribed. To date, however, there has been no systematic attempt to examine patient-related barriers to the management of pain in AIDS . This study examines potential patient-related barriers to pain manag ement in patients with AIDS using the Barriers Questionnaire (Ward et al., Pain, 52 (1993) 319-324), and assesses gender, racial, and other demographic differences in the endorsement of these barriers. We surve yed 199 ambulatory patients with AIDS, recruited from numerous sites i n New York City, as part of an ongoing study of pain and quality of li fe in ambulatory AIDS patients. In addition to obtaining demographic a nd medical data, we administered a number of self-report questionnaire s including the Brief Pain Inventory (BPI), the Brief Symptom Index (B SI), the Beck Depression Inventory (BDI), and the Memorial Symptom Ass essment Scale (MSAS). Barriers to pain management were assessed using a modified version of the Barriers Questionnaire (BQ), including the o riginal 27 questions from this self-report instrument along with an ad ditional 12 items developed for an AIDS population. Results indicated that the most frequently endorsed BQ items were those concerning the a ddiction potential of pain medications and physical discomfort associa ted with opioid administration (e.g. injections) or side effects (e.g. nausea, constipation). There were no associations between age, gender , or HIV transmission risk factor and total scores on the BQ; however, Caucasian patients endorsed significantly fewer BQ items than did non -Caucasian patients and years of education was negatively correlated w ith BQ scores. Scores on the BQ were also significantly correlated wit h number of physical symptoms (MSAS) and scores on several self-report measures of psychological distress (the BSI Global Distress Index, BD I total scores). Patient related barriers (i.e. BQ total scores) were significantly associated with undertreatment of pain (as measured by t he Pain Management Index), and added significantly to the prediction o f undertreatment in a logistic regression analysis, even after control ling for the impact of gender, education and IDU transmission risk fac tor. These data suggest that patient-related barriers to pain manageme nt may add to the already considerable likelihood of undertreatment of AIDS-related pain. (C) 1998 International Association for the Study o f Pain. Published by Elsevier Science B.V.