Association of Pain and Brain Morphometric Abnormalities in Ambulatory HIV Patients

Abstract

Pain is a major complaint of HIV-seropositive (HIV+) patients despite their well-suppressed viremia with highly active antiretroviral therapy (HAART). Investigating brain abnormalities in relation to pain symptoms in HIV+ individuals could provide potential objective biomarkers to assess and monitor pain during treatment in these patients. We used Patient Reported Outcome Measurement Information System (PROMIS®) pain questionnaire to evaluate pain symptoms and brain MRI to assess brain morphometry in HIV+ individuals and seronegative (SN) controls. We correlated the pain measures (pain intensity, pain interference and pain behavior) to brain morphometry (cortical area, cortical thickness and subcortical volumes processed with FreeSurfer), in 12 regions of interest within the pain matrix. HIV+ participants had higher scores than SN controls (p<0.05 on all 3 pain measures). HIV+ individuals with higher pain scores had larger cortical areas, thinner cortices and larger subcortical volumes, while SN controls with higher pain scores had smaller cortical areas, thicker cortices and smaller subcortical volumes. These differences in the relationships between brain abnormalities and pain scores in HIV+ individuals and SN controls suggest that HIV+ individuals have different pain response compare to SN individuals. Since the abnormal brain regions that showed significant correlation with pain symptoms belong to the affective component of the pain matrix, a multimodal approach in pain management of HIV+ individuals that additionally treat the affective symptoms may be warranted. Lastly, the lower pain scores in participants with better global health, regardless of HIV-serostatus, further suggests that adequate pain treatment can lead to better quality of life.