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The mediating role of pain in substance use and depressive symptoms among Multicenter AIDS Cohort Study (MACS) participants

Tsao, JCI and Stein, JA and Ostrow, D and Stall, RD and Plankey, MW (2011) The mediating role of pain in substance use and depressive symptoms among Multicenter AIDS Cohort Study (MACS) participants. Pain, 152 (12). 2757 - 2764. ISSN 0304-3959

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Pain in human immunodeficiency virus (HIV) frequently co-occurs with substance use and depression. The complex associations among patient characteristics, pain, depression, and drug use in HIV suggests a role for testing models that can account for relationships simultaneously, control for HIV status, and also test for mediation. Using structural equation modeling, the current study examined associations among pain, sociodemographics, illicit drug use, and depressive symptoms in 921 HIV-seropositive and 1019 HIV-seronegative men from the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural history of HIV infection among gay/bisexual men. Longitudinal repeated measures data collected over a 6-year period were analyzed using predictive path models in which sociodemographics, HIV status, and CD4+ cell counts predicted pain, which, in turn, predicted depressive symptoms and illicit drug use. The path models did not differ substantially between HIV-seropositive and -seronegative men. Analyses using the total sample indicated that pain served both as a mediator and as a predictor of more use of cannabis, cocaine, and heroin, as well as more depressive symptoms. HIV-seropositive status predicted more use of inhaled nitrites. In this cohort, having lower CD4+ cell counts (predicted by HIV status), being African American, less educated, and older were all associated with more pain, which, in turn, was associated with more illicit drug use and more depressive symptoms. The results underscore the need for adequate pain management, particularly among vulnerable subgroups of HIV-seropositive and HIV-seronegative men to reduce the risk of drug use and depression. © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Tsao, JCI
Stein, JA
Ostrow, D
Stall, RDrstall@pitt.eduRSTALL
Plankey, MW
Centers: Other Centers, Institutes, Offices, or Units > Center for LGBT Health Research
Date: 1 December 2011
Date Type: Publication
Journal or Publication Title: Pain
Volume: 152
Number: 12
Page Range: 2757 - 2764
DOI or Unique Handle: 10.1016/j.pain.2011.08.024
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Refereed: Yes
ISSN: 0304-3959
MeSH Headings: Acquired Immunodeficiency Syndrome--epidemiology; Adult; Chronic Pain--epidemiology; Cohort Studies; Comorbidity--trends; Depressive Disorder--epidemiology; Humans; Longitudinal Studies; Male; Middle Aged; Pain Measurement--methods; Prospective Studies; Questionnaires--standards; Substance-Related Disorders--epidemiology
Other ID: NLM NIHMS321913, NLM PMC3215839
PubMed Central ID: PMC3215839
PubMed ID: 21962911
Date Deposited: 12 Jun 2013 21:39
Last Modified: 02 Feb 2019 15:55


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