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Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy |
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| Authors: | J. Robinson-Papp S. Morgello C. Fitzsimons K.J. Elliott B.B. Gelman C.M. Marra J.H. Atkinson I. Grant |
| Affiliation: | a Department of Neurology, Mount Sinai, School of Medicine, New York, NY, USA b Department of Pathology, Mount Sinai School of Medicine, New York, NY, USA c Department of Family and Preventative Medicine, University of California, San Diego, USA d Department of Psychiatry, University of California, San Diego, USA e Department of Neurology, Washington University, School of Medicine, St. Louis, MO, USA f Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA g Department of Neurology, University of Washington, Seattle, WA, USA h Department of Medicine, University of California, San Diego, USA i Department of Anesthesiology, University of Rochester, Rochester, NY, USA j Department of Neurosciences, University of California, San Diego, USA |
| 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 |
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