Impact of the COVID-19 pandemic on pain prevalence and management among people living with HIV in Ontario


BACKGROUND: People living with HIV (PLWH) are disproportionately affected by high rates of pain with significant gaps in pain management. The COVID-19 pandemic has amplified these challenges through limited access to service providers, substance use treatment and harm reduction services, amid increased psychosocial stresses and financial burdens. We set out to characterize the prevalence, severity, functional impact, and treatment of pain among PLWH in Ontario, Canada, prior to and during the first year of the COVID-19 pandemic.
METHODS: The Ontario HIV Treatment Network Cohort Study (OCS) is an observational, open dynamic cohort of PLWH in Ontario, Canada. Interviews using a standardized questionnaire are administered on a yearly basis. Individuals who completed the OCS questionnaire in 2019 (pre-pandemic period) or 2020 (pandemic period) were included in the analysis. Pain prevalence and severity in the preceding 3 months, functional impact in the preceding week (measured as a mean of 7 interference items, each scored on a 0-10 scale) and treatment were evaluated in each study period.
RESULTS: A total of 2874 participants with a median (interquartile range) age of 53 (43, 60) years (77% men) were included in the analysis. Prevalence of pain was 66% in 2019 and 74% in 2020, with a fifth of participants reporting severe pain. Functional impact of pain was higher during the pandemic with 91% of those experiencing pain reporting some degree of interference with daily activities (vs 85% pre-pandemic) with a mean (standard deviation) interference score of 3.6 (1.6), compared to 3.0 (1.6) in 2019. A total of 54% of individuals in 2019 and 62% in 2020 reported receiving formal treatment for pain. In the first year of the pandemic, utilization of prescription analgesics increased (33% vs 25% in 2019) along with use of over-the-counter agents (55% vs 27% in 2019) and recreational substances (18% vs 10% in 2019), while use of non-pharmacological methods remained stable (21% during both periods).
CONCLUSIONS: Prevalence and functional impact of pain among PLWH in the OCS has increased during the COVID-19 pandemic with increased reliance on pharmacological and recreational substances. Addressing barriers to pain management among PLWH requires interdisciplinary, system-based strategies.

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