Pain and Use of Health Services Among Persons Living with HIV

  • Aram Dobalian
  • Jennie C. I. Tsao
  • Lonnie K. Zeltzer


Pain is a significant factor in a person’s decision to use health services. Moreover, pain is a particularly important factor in the use of health services among persons living with chronic conditions such as human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). In addition, pain has a far-reaching impact on the health-related quality of life (HRQOL) of persons living with HIV. Nevertheless, the manner in which pain influences an individual to seek out health care remains poorly understood despite the fact that pain is a common experience for both adults and children. This chapter summarizes the role of pain in HIV and begins with a synopsis of epidemiologic studies on the prevalence of pain symptoms with a focus on chronic pain. This is followed by a synthesis of the existing evidence-base of studies of pain and the use of health services using Andersen’s Behavioral Model of Health Services Use and includes discussions of both conventional health services and complementary and alternative medicine (CAM) approaches where such studies exist. In this conceptual framework, pain should be considered a perceived need characteristic since a person assesses his or her own pain. Pain is also currently conceptualized as a multidimensional construct that includes social, psychological, and physiological components. Thus, it is not surprising that pain often co-occurs with other health conditions. This chapter also addresses the role of comorbid psychological disorders and substance abuse in the use of health services among persons experiencing pain. Finally, the chapter describes gaps in existing knowledge regarding the role of pain in the use of health services among persons living with HIV, and makes suggestions regarding future directions for this field.


Human Immunodeficiency Virus Chronic Pain Psychological Distress Irritable Bowel Syndrome Health Service Utilization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Research by the first and second authors is supported in part by R03 DA017026 (PI: Tsao) awarded by the National Institute on Drug Abuse.


  1. Abrams, D. I., Jay, C. A., Shade, S. B., Vizoso, H., Reda, H., Press, S., et al. (2007). Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial. Neurology, 68(7), 515–521.PubMedCrossRefGoogle Scholar
  2. Aires, E. M., & Bammann, R. H. (2005). Pain in hospitalized HIV-positive patients: Clinical and therapeutical issues. The Brazilian Journal of Infectious Diseases, 9(3), 201–208.PubMedGoogle Scholar
  3. Alonzo, A. A. (1984). An illness behavior paradigm: A conceptual exploration of a situational-adaptation perspective. Social and Science Medicine, 19(5), 499–510.CrossRefGoogle Scholar
  4. Alonzo, A. A. (1985). An analytic typology of disclaimers, excuses and justifications surrounding illness: A situational approach to health and illness. Social and Science Medicine, 21(2), 153–162.CrossRefGoogle Scholar
  5. Andersen, R. M. (1968). A behavioral model of families' use of health services (No. Research Series no. 25). Chicago: Center for Administration Studies, University of Chicago.Google Scholar
  6. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.PubMedCrossRefGoogle Scholar
  7. Andersson, H. I., Ejlertsson, G., Leden, I., & Schersten, B. (1999). Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study. Journal of Epidemiology and Community Health, 53(8), 503–509.PubMedCrossRefGoogle Scholar
  8. Astin, J. A. (1998). Why patients use alternative medicine: Results of a national study. JAMA, 279, 1548–1553.PubMedCrossRefGoogle Scholar
  9. Atkinson, J. H., Jr., Grant, I., Kennedy, C. J., Richman, D. D., Spector, S. A., & McCutchan, J. A. (1988). Prevalence of psychiatric disorders among men infected with human immunodeficiency virus. A controlled study. Archives of General Psychiatry, 45(9), 859–864.PubMedGoogle Scholar
  10. Barsky, A. J. (1986). Palliation and symptomatic relief. Archives of Internal Medicine, 146(5), 905–909.PubMedCrossRefGoogle Scholar
  11. Basu, S., Chwastiak, L. A., & Bruce, R. D. (2005). Clinical management of depression and anxiety in HIV-infected adults. Aids, 19(18), 2057–2067.PubMedCrossRefGoogle Scholar
  12. Bausell, R. B., Lee, W., & Berman, B. M. (2001). Demographic and health-related correlates of visits to complementary and alternative medical providers. Medical Care, 39, 190–196.PubMedCrossRefGoogle Scholar
  13. Blair, J. M., Fleming, P. L., & Karon, J. M. (2002). Trends in AIDS incidence and survival among racial/ethnic minority men who have sex with men, United States, 1990–1999. Journal of Acquired Immune Deficiency Syndromes, 31(3), 339–347.PubMedGoogle Scholar
  14. Blyth, F. M., March, L. M., Brnabic, A. J., & Cousins, M. J. (2004). Chronic pain and frequent use of health care. Pain, 111(1–2), 51–58.PubMedCrossRefGoogle Scholar
  15. Blyth, F. M., March, L. M., Brnabic, A. J., Jorm, L. R., Williamson, M., & Cousins, M. J. (2001). Chronic pain in Australia: A prevalence study. Pain, 89(2–3), 127–134.PubMedCrossRefGoogle Scholar
  16. Bozzette, S., Berry, S., Duan, N., Frankel, M., Leibowitz, A., Lefkowitz, D., et al. (1998). The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium. The New England Journal of Medicine, 339(26), 1897–1904.PubMedCrossRefGoogle Scholar
  17. Brattberg, G., Thorslund, M., & Wikman, A. (1989). The prevalence of pain in a general population. The results of a postal survey in a county of Sweden. Pain, 37(2), 215–222.PubMedCrossRefGoogle Scholar
  18. Breitbart, W., Kaim, M., & Rosenfeld, B. (1999). Clinicans’ perceptions of barriers to pain management in AIDS. Journal of Pain and Symptom Management, 18, 203–212.PubMedCrossRefGoogle Scholar
  19. Breitbart, W., & McDonald, M. V. (1996). Pharmacologic pain management in HIV/AIDS. Journal of International Association of Physicians in AIDS Care, 2(7), 17–26.Google Scholar
  20. Breitbart, W., McDonald, M. V., Rosenfeld, B., Passik, S. D., Hewitt, D., Thaler, H., et al. (1996). Pain in ambulatory AIDS patients. I: Pain characteristics and medical correlates. Pain, 68(2–3), 315–321.PubMedCrossRefGoogle Scholar
  21. Breitbart, W., Passik, S., McDonald, M., Rosenfeld, B., Smith, M., Kaim, M., et al. (1998). Patient-related barriers to pain management in ambulatory AIDS patients. Pain, 76, 9–16.PubMedCrossRefGoogle Scholar
  22. Breitbart, W., Rosenfeld, B. D., Passik, S. D., McDonald, M. V., Thaler, H., & Portenoy, R. K. (1996). The undertreatment of pain in ambulatory AIDS patients. Pain, 65(2–3), 243–249.PubMedCrossRefGoogle Scholar
  23. Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain, 10(4), 287–333.PubMedCrossRefGoogle Scholar
  24. Bridges, K. W., & Goldberg, D. P. (1985). Somatic presentation of DSM III psychiatric disorders in primary care. Journal of Psychosomatic Research, 29(6), 563–569.PubMedCrossRefGoogle Scholar
  25. Campo, J. V., Comer, D. M., Jansen-Mcwilliams, L., Gardner, W., & Kelleher, K. J. (2002). Recurrent pain, emotional distress, and health service use in childhood. Journal of Pediatrics, 141(1), 76–83.PubMedCrossRefGoogle Scholar
  26. Campo, J. V., Jansen-McWilliams, L., Comer, D. M., & Kelleher, K. J. (1999). Somatization in pediatric primary care: Association with psychopathology, functional impairment, and use of services. Journal of American Academy Child and Adolescent Psychiatry, 38(9), 1093–1101.Google Scholar
  27. Caudill, M., Schnable, R., Zuttermeister, P., Benson, H., & Friedman, R. (1991). Decreased clinic use by chronic pain patients: Response to behavioral medicine intervention. Clinical Journal of Pain, 7(4), 305–310.PubMedGoogle Scholar
  28. Centers for Disease Control and Prevention. (2005). HIV/AIDS Surveillance Report. 16, 20.Google Scholar
  29. Chrubasik, S., Junck, H., Zappe, H. A., & Stutzke, O. (1998). A survey on pain complaints and health care utilization in a German population sample. European Journal of Anaesthesiology, 15(4), 397–408.PubMedGoogle Scholar
  30. Croft, P., Rigby, A. S., Boswell, R., Schollum, J., & Silman, A. (1993). The prevalence of chronic widespread pain in the general population. Journal of Rheumatology, 20(4), 710–713.PubMedGoogle Scholar
  31. Cunningham, W. E., Andersen, R. M., Katz, M. H., Stein, M. D., Turner, B. J., Crystal, S., et al. (1999). The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Medical Care, 37(12), 1270–1281.PubMedCrossRefGoogle Scholar
  32. Cunningham, W. E., Hays, R. D., Duan, N., Andersen, R., Nakazono, T. T., Bozzette, S. A., et al. (2005). The effect of socioeconomic status on the survival of people receiving care for HIV infection in the United States. Journal of Health Care for the Poor and Underserved, 16(4), 655–676.PubMedGoogle Scholar
  33. Derogatis, L. R. (1994). SCL-90-R Symptom Checklist-90-R. Mineapolis, MN: National Computer Systems, Inc.Google Scholar
  34. Detels, R., Munoz, A., McFarlane, G., Kingsley, L. A., Margolick, J. B., Giorgi, J., et al. (1998). Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators. JAMA, 280(17), 1497–1503.PubMedCrossRefGoogle Scholar
  35. Dobalian, A., Andersen, R. M., Stein, J. A., Hays, R. D., Cunningham, W. E., & Marcus, M. (2003). The impact of HIV on oral health and subsequent use of dental services. Journal of Public Health Dentistry, 63(2), 78–85.PubMedGoogle Scholar
  36. Dobalian, A., Tsao, J. C. I., & Duncan, R. P. (2004). The role of pain in the use of outpatient services among persons with HIV: Results from a nationally representative survey. Medical Care, 42, 129–138.PubMedCrossRefGoogle Scholar
  37. Douaihy, A. B., Stowell, K. R., Kohnen, S., Stoklosa, J. B., & Breitbart, W. S. (2007a). Psychiatric aspects of comorbid HIV/AIDS and pain, Part 1. AIDS Reader, 17(6), 310–314.Google Scholar
  38. Douaihy, A. B., Stowell, K. R., Kohnen, S., Stoklosa, J. B., & Breitbart, W. S. (2007b). Psychiatric aspects of comorbid HIV/AIDS and pain, Part 2. AIDS Reader, 17(7), 350–352, 357–361.Google Scholar
  39. Drossman, D. A., McKee, D. C., Sandler, R. S., Mitchell, C. M., Cramer, E. M., Lowman, B. C., et al. (1988). Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology, 95(3), 701–708.PubMedGoogle Scholar
  40. Eisenberg, D. M., Davis, R. B., Ettner, S. L., Appel, S., Wilkey, S., Van Rompay, M., et al. (1998). Trends in alternative medicine use in the United States, 1990–1997. JAMA, 280, 1569–1575.PubMedCrossRefGoogle Scholar
  41. Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R., & Delbanco, T. L. (1993). Unconventional medicine in the United States: Prevalence, costs, and patterns of use. TheNew England Journal of Medicine, 328, 246–252.CrossRefGoogle Scholar
  42. Emanuel, E. J., & Emmanuel, L. L. (2004). Palliative and end-of-life care. In D. L. Kasper, E. Braunwald, A. S. Fauci, S. L. Hauser, D. L. Longo & J. L. Jameson (Eds.), Harrison’s Principles of Internal Medicine (16th ed., pp. 53). New York: McGraw-Hill.Google Scholar
  43. Fairfield, K. M., Eisenbeg, D. M., Davis, R. G., Libman, H., & Phillips, R. S. (1988). Patterns of use, expenditures, and perceived efficacy of complementary and alternative therapies in HIV-infected patients. Archives of Internal Medicine, 158, 2257–2264.CrossRefGoogle Scholar
  44. Fleishman, J. A., Gebo, K. A., Reilly, E. D., Conviser, R., Christopher Mathews, W., Todd Korthuis, P., et al. (2005). Hospital and outpatient health services utilization among HIV-infected adults in care 2000–2002. Medical Care, 43(9 Suppl), III40–52.PubMedGoogle Scholar
  45. Foster, P. H. (2007). Use of Stigma, Fear, and Denial in Development of a Framework for Prevention of HIV/AIDS in Rural African American Communities. Family and Community Health, 30(4), 318–327.PubMedGoogle Scholar
  46. Frich, L. M., & Borgbjerg, F. M. (2000). Pain and pain treatment in AIDS patients: a Longitudinal study. Journal of Pain and Symptom Management, 19(5), 339–347.PubMedCrossRefGoogle Scholar
  47. Frolund, F., & Frolund, C. (1986). Pain in general practice. Pain as a cause of patient-doctor contact. Scandinavian Journal of Primary Health Care, 4(2), 97–100.PubMedCrossRefGoogle Scholar
  48. Gaughan, D. M., Hughes, M. D., Seage, G. R., 3rd, Selwyn, P. A., Carey, V. J., Gortmaker, S. L., et al. (2002). The prevalence of pain in pediatric human immunodeficiency virus/acquired immunodeficiency syndrome as reported by participants in the Pediatric Late Outcomes Study (PACTG 219). Pediatrics, 109(6), 1144–1152.PubMedCrossRefGoogle Scholar
  49. Gonzalez-Duarte, A., Cikurel, K., & Simpson, D. M. (2007). Managing HIV Peripheral Neuropathy. Current HIV/AIDS Reports, 4(3), 114–118.PubMedCrossRefGoogle Scholar
  50. Haetzman, M., Elliott, A. M., Smith, B. H., Hannaford, P., & Chambers, W. A. (2003). Chronic pain and the use of conventional and alternative therapy. Family Practice, 20(2), 147–154.PubMedCrossRefGoogle Scholar
  51. Harrison, J. A., Mullen, P. D., & Green, L. W. (1992). A Meta-Analysis of Studies of the Health Belief Model. Health Education Research, 7, 107–116.PubMedCrossRefGoogle Scholar
  52. Hays, R. D., & Morales, L. S. (2001). The RAND-36 measure of health-related quality of life. Annals of Medicine, 33(5), 350–357.PubMedCrossRefGoogle Scholar
  53. Health Resources and Services Administration. (2006). Ryan White CARE Act Annual Data Summary (for Calendar Year 2004). Washington, DC: U.S. Department of Health and Human Services.Google Scholar
  54. Hellinger, F. J., & Fleishman, J. A. (2000). Estimating the national cost of treating people with HIV disease: Patient, payer, and provider data. Journal of Acquired Immune Deficiency Syndrome, 24(2), 182–188.Google Scholar
  55. Heslin, K. C., Andersen, R. M., Ettner, S. L., & Cunningham, W. E. (2005). Racial and ethnic disparities in access to physicians with HIV-related expertise. Journal of Genral Internal Medicine, 20(3), 283–289.CrossRefGoogle Scholar
  56. Hewitt, D. J., McDonald, M., Portenoy, R. K., Rosenfeld, B., Passik, S., & Breitbart, W. (1997). Pain syndromes and etiologies in ambulatory AIDS patients. Pain, 70(2–3), 117–123.PubMedCrossRefGoogle Scholar
  57. Jain, S., Schwarcz, S., Katz, M., Gulati, R., & McFarland, W. (2006). Elevated risk of death for African Americans with AIDS, San Francisco, 1996–2002. Journal of Health Care for the Poor and Underserved, 17(3), 493–503.PubMedCrossRefGoogle Scholar
  58. Josephs, J. S., Fleishman, J. A., Gaist, P., & Gebo, K. A. (2007). Use of complementary and alternative medicines among a multistate, multisite cohort of people living with HIV/AIDS. HIV Medicine, 8(5), 300–305.PubMedCrossRefGoogle Scholar
  59. Kates, J., Penner, M., Crutsinger-Perry, B., Carbaugh, A. L., & Singleton, N. (2006). National ADAP Monitoring Project, Annual Report, 2006. Washington, DC: The National Alliance of State and Territorial AIDS Directors.Google Scholar
  60. Katon, W., Kleinman, A., & Rosen, G. (1982a). Depression and somatization: A review. Part I. American Journal of Medicine, 72(1), 127–135.Google Scholar
  61. Katon, W., Kleinman, A., & Rosen, G. (1982b). Depression and somatization: A review. Part II. American Journal of Medicine, 72(2), 241–247.Google Scholar
  62. Keefe, R. H. (2003). Containing the cost of care for people living with HIV/AIDS: An examination of the Medicaid managed care approach. Journal of Health and Social Policy, 17(3), 41–53.PubMedCrossRefGoogle Scholar
  63. Kelleher, K. J., Childs, G. E., Wasserman, R. C., McInerny, T. K., Nutting, P. A., & Gardner, W. P. (1997). Insurance status and recognition of psychosocial problems. A report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Networks. Archives of Pediatrics and Adolescent Medicine, 151(11), 1109–1115.PubMedGoogle Scholar
  64. Kerns, R. D., Otis, J., Rosenberg, R., & Reid, M. C. (2003). Veterans’ reports of pain and associations with ratings of health, health-risk behaviors, affective distress, and use of the healthcare system. Journal of Rehabilitation Resarch and Development, 40(5), 371–379.CrossRefGoogle Scholar
  65. Kinsler, J. J., Wong, M. D., Sayles, J. N., Davis, C., & Cunningham, W. E. (2007). The Effect of Perceived Stigma from a Health Care Provider on Access to Care Among a Low-Income HIV-Positive Population. AIDS Patient Care STDS, 21(8), 584–592.PubMedCrossRefGoogle Scholar
  66. Knippels, H. M. A., & Weiss, J. J. (2000). Use of alternative medicine in a sample of HIV-positive gay men: An exploratory study of prevalence and user characteristics. AIDS Care, 12, 435–446.PubMedCrossRefGoogle Scholar
  67. Koch, H. (1986). The management of chronic pain in office-based ambulatory care: National Ambulatory Medical Care Survey. Advance Data for Vital and Health Statistics, no. 123. DHHS publ. no. (PHS) 86–1250. Hyattsville, MD: Public Health Service.Google Scholar
  68. Kohlmann, T. (1991). Schmerzen in der Lubecker Bevolkerung. Ergebnisse einer bevolkerungsepidemiologischen studies. Der Schmerz, 5, 208–213.PubMedCrossRefGoogle Scholar
  69. Korten, A. E., Jacomb, P. A., Jiao, Z., Christensen, H., Jorm, A. F., Henderson, A. S., et al. (1998). Predictors of GP service use: A community survey of an elderly Australian sample. Australian and New Zealand Journal of Public Health, 22(5), 609–615.PubMedCrossRefGoogle Scholar
  70. Landon, B. E., Wilson, I. B., Wenger, N. S., Cohn, S. E., Fichtenbaum, C. J., Bozzette, S. A., et al. (2002). Specialty training and specialization among physicians who treat HIV/AIDS in the United States. Journal of General Internal Medicine, 17(1), 12–22.PubMedCrossRefGoogle Scholar
  71. Larue, F., Fontaine, A., & Colleau, S. M. (1997). Underestimation and undertreatment of pain in HIV disease: Multicentre study. BMJ, 314(7073), 23–28.PubMedGoogle Scholar
  72. Lavy, V. (2007). Presenting symptoms and signs in children referred for palliative care in Malawi. Palliative Medicine, 21(4), 333–339.PubMedCrossRefGoogle Scholar
  73. Lebovits, A. H., Lefkowitz, M., & McCarthy, D. (1989). The prevalence and mangement of pain in patients with AIDS: A review of 134 cases. The Clinical Journal of Pain, 5, 245–248.PubMedCrossRefGoogle Scholar
  74. Leserman, J., Whetten, K., Lowe, K., Stangl, D., Swartz, M. S., & Thielman, N. M. (2005). How trauma, recent stressful events, and PTSD affect functional health status and health utilization in HIV-infected patients in the south. Psychosomatic Medicine, 67(3), 500–507.PubMedCrossRefGoogle Scholar
  75. Leventhal, H. (1986). Symptom reporting: A focus on process. In S. McHugh & T. M. Vallis (Eds.), Illness Behavior: A Mulidisciplinary Model. New York: Plenum Press.Google Scholar
  76. Liebschutz, J. M., Feinman, G., Sullivan, L., Stein, M., & Samet, J. (2000). Physical and sexual abuse in women infected with the human immunodeficiency virus: Increased illness and health care utilization. Archices of Internal Medicine, 160(11), 1659–1664.CrossRefGoogle Scholar
  77. Lolekha, R., Chanthavanich, P., Limkittikul, K., Luangxay, K., Chotpitayasunodh, T., & Newman, C. J. (2004). Pain: A common symptom in human immunodeficiency virus-infected Thai children. Acta Paediatrica, 93(7), 891–898.PubMedCrossRefGoogle Scholar
  78. London, A. S., Foote-Ardah, C. E., Fleishman, J. A., & Shapiro, M. F. (2003). Use of alternative therapists among people in care for HIV in the United States. American Journal of Public Health, 93(6), 980–987.PubMedCrossRefGoogle Scholar
  79. Lorenz, K. A., Shapiro, M. F., Asch, S. M., Bozzette, S. A., & Hays, R. D. (2001). Associations of symptoms and health-related quality of life: Findings from a national study of persons with HIV infection. Annals of Internal Medicne, 134(9 Pt 2), 854–860.Google Scholar
  80. Marcus, K. S., Kerns, R. D., Rosenfeld, B., & Breitbart, W. (2000). HIV/AIDS-related pain as a chronic pain condition: Implications of a biopsychosocial model for comprehensive assessment and effective management. Pain Medicine, 1(3), 260–273.PubMedCrossRefGoogle Scholar
  81. McCallum, J., Simons, L., Simons, J., Wilson, J., Sadler, P., & Owen, A. (1996). Patterns and costs of post-acute care: A longitudinal study of people aged 60 and over in Dubbo. Australian and New Zealand Journal of Public Health, 20(1), 19–26.PubMedCrossRefGoogle Scholar
  82. McCarthy, G. (1992). Host factors associated with HIV-related oral candidiasis. A review. Oral Surgery, Oral Medicine, and Oral Pathology, 73, 181–186.PubMedCrossRefGoogle Scholar
  83. McCormack, J. P., Li, R., Zarowny, D., & Singer, J. (1993). Inadequate treatment of pain in ambulatory HIV patients. Clinical Journal of Pain, 9(4), 279–283.PubMedGoogle Scholar
  84. McFarland, W., Chen, S., Hsu, L., Schwarcz, S., & Katz, M. (2003). Low socioeconomic status is associated with a higher rate of death in the era of highly active antiretroviral therapy, San Francisco. Journal of Acquired Immune Deficiency Syndromes, 33(1), 96–103.PubMedGoogle Scholar
  85. Mechanic, D. (1972). Social psychologic factors affecting the presentation of bodily complaints. The New England Journal of Medicine, 286(21), 1132–1139.PubMedGoogle Scholar
  86. Merskey, H., Bogduk, N., & editors. (1994). Classification of chronic pain: Description of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press.Google Scholar
  87. Morin, S. F., Sengupta, S., Cozen, M., Richards, T. A., Shriver, M. D., Palacio, H., et al. (2002). Responding to racial and ethnic disparities in use of HIV drugs: Analysis of state policies. Public Health Reports, 117(3), 263–272; discussion 231–262.PubMedGoogle Scholar
  88. Ni, H., Simile, C., & Hardy, A. M. (2002). Utilization of complementary and alternative medicine by United States adults: Results from the 1999 national health interview survey. Medical Care, 40, 353–358.PubMedCrossRefGoogle Scholar
  89. Norval, D. A. (2004). Symptoms and sites of pain experienced by AIDS patients. S African Medical Journal, 94(6), 450–454.Google Scholar
  90. Ostrow, M. J., Cornelisse, P. G., Heath, K. V., Craib, K. J., Schechter, M. T., O’Shaughnessy, M., et al. (1997). Determinants of complementary therapy use in HIV-infected individuals receiving antiretroviral or anti-opportunistic agents. J Acquir Immune Defic Syndr Hum Retrovirol, 15, 115–120.PubMedGoogle Scholar
  91. Palella, F. J., Jr., Delaney, K. M., Moorman, A. C., Loveless, M. O., Fuhrer, J., Satten, G. A., et al. (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. The New England Journal of Medicine, 338(13), 853–860.PubMedCrossRefGoogle Scholar
  92. Parveen, Z., Acheampong, E., Pomerantz, R. J., Jacobson, J. M., Wigdahl, B., & Mukhtar, M. (2007). Effects of highly active antiretroviral therapy on HIV-1-associated oral complications. Current HIV Research, 5(3), 281–292.PubMedCrossRefGoogle Scholar
  93. Perquin, C. W., Hazebroek-Kampschreur, A. A., Hunfeld, J. A., Bohnen, A. M., van Suijlekom-Smit, L. W., Passchier, J., et al. (2000). Pain in children and adolescents: A common experience. Pain, 87(1), 51–58.PubMedCrossRefGoogle Scholar
  94. Phillips, K. A., Morrison, K. R., Andersen, R., & Aday, L. A. (1998). Understanding the context of healthcare utilization: Assessing environmental and provider-related variables in the behavioral model of utilization. Health Service Research, 33(3 Pt 1), 571–596.Google Scholar
  95. Potter, R. G., & Jones, J. M. (1992). The evolution of chronic pain among patients with musculoskeletal problems: A pilot study in primary care. British Journal of Genral Practice, 42(364), 462–464.Google Scholar
  96. Prohaska, T. R., Keller, M. L., Leventhal, E. A., & Leventhal, H. (1987). Impact of symptoms and aging attribution on emotions and coping. Health Psychology, 6(6), 495–514.PubMedCrossRefGoogle Scholar
  97. Pugh, K., Riccio, M., Jadresic, D., Burgess, A. P., Baldeweg, T., Catalan, J., et al. (1994). A longitudinal study of the neuropsychiatric consequences of HIV-1 infection in gay men. II. Psychological and health status at baseline and at 12-month follow-up. Psychological Medicine, 24(4), 897–904.PubMedCrossRefGoogle Scholar
  98. Ramirez-Amador, V., Ponce-de-Leon, S., Anaya-Saavedra, G., Crabtree Ramirez, B., & Sierra-Madero, J. (2007). Oral lesions as clinical markers of highly active antiretroviral therapy failure: A nested case-control study in Mexico City. Clinical Infectious Diseases, 45(7), 925–932.PubMedCrossRefGoogle Scholar
  99. Robbins, J. L., Phillips, K. D., Dudgeon, W. D., & Hand, G. A. (2004). Physiological and psychological correlates of sleep in HIV infection. Clinical Nursing Research, 13(1), 33–52.PubMedCrossRefGoogle Scholar
  100. Rosenblatt, A. B., & Mekhail, N. A. (2005). Management of pain in addicted/illicit and legal substance abusing patients. Pain Practice, 5(1), 2–10.PubMedCrossRefGoogle Scholar
  101. Rosenfeld, B., Breitbart, W., McDonald, M. V., Passik, S. D., Thaler, H., & Portenoy, R. K. (1996). Pain in ambulatory AIDS patients. II: Impact of pain on psychological functioning and quality of life. Pain, 68(2–3), 323–328.PubMedCrossRefGoogle Scholar
  102. Rosenstock, I. M. (1974). Historical origins of the Health Belief Model. Health Education Monograph, 2, 344.Google Scholar
  103. Roth-Isigkeit, A., Thyen, U., Raspe, H. H., Stoven, H., & Schmucker, P. (2004). Reports of pain among German children and adolescents: An epidemiological study. Acta Paediatrica, 93(2), 258–263.PubMedCrossRefGoogle Scholar
  104. Sambamoorthi, U., Walkup, J., Olfson, M., & Crystal, S. (2000). Antidepressant treatment and health services utilization among HIV-infected medicaid patients diagnosed with depression. Journal of General Internal Medicine, 15(5), 311–320.PubMedCrossRefGoogle Scholar
  105. Sayles, J. N., Ryan, G. W., Silver, J. S., Sarkisian, C. A., & Cunningham, W. E. (2007). Experiences of Social Stigma and Implications For Healthcare Among a Diverse Population of HIV Positive Adults. Journal of Urban Health, 84(6), 814–818.PubMedCrossRefGoogle Scholar
  106. Schofferman, J., & Brody, R. (1990). Pain in far advanced AIDS. In R. Chapman & K. Foley (Eds.), Advances in Pain Research and Therapy (Vol. 16, pp. 379–386). New York: Raven Press.Google Scholar
  107. Shapiro, M. F., Morton, S. C., McCaffrey, D. F., Senterfitt, J. W., Fleishman, J. A., Perlman, J. F., et al. (1999). Variations in the care of HIV-infected adults in the United States: Results from the HIV Cost and Services Utilization Study. JAMA, 281(24), 2305–2315.PubMedCrossRefGoogle Scholar
  108. Silverman, S. J., Migliorati, C., Lozada-Nur, F., Greenspan, D., & Conant, M. (1986). Oral findings in people with or at high risk for AIDS: A study of 375 homosexual males. Journal of American Dental Association, 112(2), 187–192.Google Scholar
  109. Simmonds, M. J., Novy, D., & Sandoval, R. (2005). The differential influence of pain and fatigue on physical performance and health status in ambulatory patients with human immunodeficiency virus. Clinical Journal of Pain, 21(3), 200–206.PubMedCrossRefGoogle Scholar
  110. Simmons, J. W., Avant, W. S., Jr., Demski, J., & Parisher, D. (1988). Determining successful pain clinic treatment through validation of cost effectiveness. Spine, 13(3), 342–344.PubMedCrossRefGoogle Scholar
  111. Singer, E. J., Zorilla, C., Fahy-Chandon, B., Chi, S., Syndulko, K., & Tourtellotte, W. W. (1993). Painful symptoms reported by ambulatory HIV-infected men in a longitudinal study. Pain, 54(1), 15–19.PubMedCrossRefGoogle Scholar
  112. Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2002). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press.Google Scholar
  113. Smith, M. Y., Egert, J., Winkel, G., & Jacobson, J. (2002). The impact of PTSD on pain experience in persons with HIV/AIDS. Pain, 98(1–2), 9–17.PubMedCrossRefGoogle Scholar
  114. Stewart, A. L., & Ware, J. E. (1992). Measuring functioning and well-being : The medical outcomes study approach. Durham: Duke University Press.Google Scholar
  115. Szpalski, M., Nordin, M., Skovron, M. L., Melot, C., & Cukier, D. (1995). Health care utilization for low back pain in Belgium. Influence of sociocultural factors and health beliefs. Spine, 20(4), 431–442.PubMedCrossRefGoogle Scholar
  116. Tobias, C. R., Cunningham, W., Cabral, H. D., Cunningham, C. O., Eldred, L., Naar-King, S., et al. (2007). Living with HIV but without medical care: Barriers to engagement. AIDS Patient Care STDS, 21(6), 426–434.PubMedCrossRefGoogle Scholar
  117. Tsao, J. C., Dobalian, A., Myers, C. D., & Zeltzer, L. K. (2005a). Pain and use of complementary and alternative medicine in a national sample of persons living with HIV. Journal of Pain and Symptom Management, 30(5), 418–432.Google Scholar
  118. Tsao, J. C., Dobalian, A., & Naliboff, B. D. (2004). Panic disorder and pain in a national sample of persons living with HIV. Pain, 109(1–2), 172–180.PubMedCrossRefGoogle Scholar
  119. Tsao, J. C., Dobalian, A., & Stein, J. A. (2005b). Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV. Pain, 119(1–3), 124–132.Google Scholar
  120. Tsao, J. C., Stein, J. A., & Dobalian, A. (2007). Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV. Pain, 133(1–3), 128–137.PubMedCrossRefGoogle Scholar
  121. Turner, B. J., Cunningham, W. E., Duan, N., Andersen, R. M., Shapiro, M. F., Bozzette, S. A., et al. (2000). Delayed medical care after diagnosis in a US national probability sample of persons infected with human immunodeficiency virus. Archived of Internal Medicine, 160(17), 2614–2622.CrossRefGoogle Scholar
  122. Valdiserri, R. O. (2002). HIV/AIDS stigma: An impediment to public health. American Journal of Public Health, 92(3), 341–342.PubMedCrossRefGoogle Scholar
  123. Verhaak, P. F., Kerssens, J. J., Dekker, J., Sorbi, M. J., & Bensing, J. M. (1998). Prevalence of chronic benign pain disorder among adults: A review of the literature. Pain, 77(3), 231–239.PubMedCrossRefGoogle Scholar
  124. Vitiello, B., Burnam, M. A., Bing, E. G., Beckman, R., & Shapiro, M. F. (2003). Use of psychotropic medications among HIV-infected patients in the United States. American Journal of Psychiatry, 160(3), 547–554.PubMedCrossRefGoogle Scholar
  125. Vogl, D., Rosenfeld, B., Breitbart, W., Thaler, H., Passik, S., McDonald, M., et al. (1999). Symptom prevalence, characteristics, and distress in AIDS outpatients. Journal of Pain and Symptom Management, 18(4), 253–262.PubMedCrossRefGoogle Scholar
  126. Von Korff, M., Dworkin, S. F., Le Resche, L., & Kruger, A. (1988). An epidemiologic comparison of pain complaints. Pain, 32(2), 173–183.CrossRefGoogle Scholar
  127. Von Korff, M., Wagner, E. H., Dworkin, S. F., & Saunders, K. W. (1991). Chronic pain and use of ambulatory health care. Psychosomatic Medicine, 53(1), 61–79.Google Scholar
  128. Vosvick, M., Gore-Felton, C., Ashton, E., Koopman, C., Fluery, T., Israelski, D., et al. (2004). Sleep disturbances among HIV-positive adults: The role of pain, stress, and social support. Journal of Psychosomatic Research, 57(5), 459–463.PubMedGoogle Scholar
  129. Weinert, M., Grimes, R., & Lynch, D. (1996). Oral manifestations of HIV infection. Annals of Internal Medicine, 125, 485–496.PubMedGoogle Scholar
  130. Welch, G. W., Hillman, L. C., & Pomare, E. W. (1985). Psychoneurotic symptomatology in the irritable bowel syndrome: A study of reporters and non-reporters. British Medical Journal (Clinical Research Ed), 291(6506), 1382–1384.Google Scholar
  131. Whitehead, W. E., Bosmajian, L., Zonderman, A. B., Costa, P. T., Jr., & Schuster, M. M. (1988). Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. Gastroenterology, 95(3), 709–714.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Aram Dobalian
    • 1
  • Jennie C. I. Tsao
  • Lonnie K. Zeltzer
  1. 1.HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System; Department of Health ServicesUCLA School of Public HealthLos AngelesUSA

Personalised recommendations