The Nature of Stigma-Pain Relation in People Living With HIV

Anxiety sensitivity may explain the association between stigma and pain among people living with HIV (PLHIV), according to a study recently published in the Journal of HIV/AIDS & Social Services.

Pain is highly common among PLHIV and is often severe and interferes with quality of life. On average, PLHIV report moderate to severe levels of pain intensity and moderate levels of pain interference. Currently, there is very little known about the role of psychological factors in the experience of pain among PLHIV. Stigma, an attribute that causes an effective sense of social devaluation, may be one such related psychological factor. Among PLHIV, stigma is associated with depression and anxiety symptoms, more HIV-related symptoms, and poorer antiviral medication adherence. With the consideration that approximately 83% of PLHIV report pain in a 3-month past prevalence range, there is a need to examine possible factors that may explain this putative association.

One such factor is anxiety sensitivity, defined as the fear of arousal-related sensations, arising from beliefs that sensations would lead to adverse consequences. It is associated with a lower pain threshold, greater sensory pain, greater pain catastrophizing, and more pain-related disability. Although the association between stigma and pain in stigmatized individuals has been well established in the non-HIV chronic pain literature, little is known about the association between stigma and pain in PLHIV and the mechanisms that underlie this association. Therefore, this study evaluated a 2-pronged hypothesis: 1) in PLHIV, stigma would be significantly associated with pain severity, pain interference, and psychological inflexibility in pain, and 2) anxiety sensitivity would explain the association between stigma and pain-related dependent measures.

A total of 97 adults with self-reported diagnosis of HIV/AIDS were included. Measures included various assessments, including 5 well-established self-reporting measures and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.

As hypothesized, HIV stigma was associated with pain severity, pain interference, and psychological inflexibility in pain. The indirect role of anxiety sensitivity in the association between HIV stigma and pain was also examined and there were significant indirect effects of HIV stigma on pain severity. HIV stigma was positively correlated with anxiety sensitivity (P <.001), pain severity (P =.018), pain interference (P <.001), and psychological inflexibility in pain (P <.001). Further, anxiety sensitivity was positively associated with pain severity (P <.001), pain interference (P <.001), and psychological inflexibility in pain (P <.001). The total effect of HIV-related stigma on pain interference was significant (P =.022). There was also a significant indirect effect of HIV-related stigma by means of anxiety sensitivity.

The investigators acknowledge the limitations of a cross-section study, as well as the need for a more heterogeneous sample and a proper catalogue of causes of reported pain. However, as a first of its kind study, the investigators stress the importance of further research and development of interventions that reduce anxiety sensitivity in stigmatized populations, stating that, “[their] findings provide novel empirical insight into the nature of stigma-pain relation among PLHIV and could be used to guide pain-based intervention development for this population.”

Reference

Wong CCY, Paulus DJ, Lemaire et al. Examining HIV-related stigma in relation to pain interference and psychological inflexibility among persons living with HIV/AIDS: the role of anxiety sensitivity. J HIV AIDS Soc Serv. 2018;17:1-15.