Cross-Cultural Differences in Patient Perceptions and Outpatient Management of Chronic HIV/AIDS-related Pain

Chronic pain is a common problem among HIV-infected persons and yet data on the prevalence, character, severity and management of HIV-related pain is lacking. No studies have evaluated cross-cultural differences in perceptions of pain and its impact on the quality of life of affected patients. The goals of this study were to examine the differences in pain intensity reports and impairment in quality of life determinants attributed to pain among American, Ethiopian and Ghanaian HIV patients. We performed a multi-center cross-sectional study in 20 American, 50 Ethiopian and 51 Ghanaian HIV patients in outpatient clinics within three tertiary referral health care facilities. Pain intensity and quality of life impairment levels were measured on a 0 to 10 Likert scale. Additionally, we also assessed demographic and socioeconomic variables and clinical characteristics of HIV disease. Clinical characteristics of HIV disease, such as CD4 cell count and presence and length of ARV therapy were not significantly different among the three cohorts. However, American patients were more likely to report higher levels of pain and more quality of life impairment, despite receiving higher levels of opioid analgesics. This study confirms the role of cultural influence on pain intensity and impact of pain on quality of life among American, Ethiopian and Ghanaian patients. Further research is warranted to better understand the present findings and future studies should attempt to explore the underling mechanisms that may explain cultural differences in pain reports.