***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: & NA ; We studied the painful symptoms associated with human immunodeficiency virus ( HIV ) infection and its treatment in a group of men enrolled in a prospect i ve longitudinal study of HIV effects on the nervous system . The most common painful illnesses reported were HIV‐related headaches , herpes simplex , painful peripheral neuropathy , back pain , herpes zoster , 3′‐azido‐3′‐deoxythymidine (AZT)‐induced headaches , throat pain , and arthralgia . Painful illnesses were reported at all stages of systemic disease but were more common in the later stages of disease and in subjects who progressed to a more advanced stage during the study period . There was an association between the frequency of multiple pains , increased disability on the Karnofsky scale , and higher depression scores , as measured by the Brief Symptom Inventory ( BSI ) . We conclude that painful symptoms are important even in relatively healthy and independent HIV‐infected men In this pilot study , we assessed feasibility and acceptability of a behavior therapy intervention for pain and depressive symptoms in persons living with HIV/AIDS ( PLWH ) . We r and omly assigned 23 participants to HIV-PASS ( HIV-Pain and Sadness Study ) or a health education control arm for 3 months . On average , participants attended more than 5 sessions ( of 7 possible ) in both arms . Qualitative data suggest HIV-PASS participants understood key messages and made concrete behavioral changes . HIV-PASS was associated with effects in the expected direction for three of four outcomes , including the primary outcome ( pain-related interference with functioning ) . Findings suggest that HIV-PASS is promising & NA ; The relationships among pain , psychological distress and other quality of life concerns were examined through a prospect i ve cross‐sectional survey of 438 ambulatory AIDS patients recruited from health care facilities in New York City . In this sample , 274 ( 62.6 % ) patients reported frequent or persistent pain during the prior 2 wks . Patients with and without pain completed a question naire packet that included measures of psychological symptom distress ( Brief Symptom Inventory and the Psychological Distress Subscale of the Memorial Symptom Assessment Scale ) , depression ( Beck Depression Inventory and Beck Hopelessness Scale ) , social support ( Social Support Question naire ) , and overall quality of life  ( Functional Living Index ‐ Cancer , modified for AIDS ) . Multivariate analyses ( MANOVA , multiple regression ) revealed significant associations between the presence and intensity of pain and scores on the measures of psychological distress , depression , hopelessness , and quality of life ( P < 0.0001 for most analyses ) . Perceived adequacy of social support was also significantly associated with lower levels of psychological distress and depression , and better quality of life . These results demonstrate the significant relationships between pain , psychological well‐being , and quality of life , and affirm the need to provide adequate treatment of pain in patients with AIDS PURPOSE To prospect ively assess rheumatic manifestations of human immunodeficiency virus ( HIV ) disease in a municipal hospital clinic population in which intravenous drug use was the most common risk factor for HIV infection . PATIENTS AND METHODS Patients with documented HIV infection were evaluated for rheumatic disease using a st and ardized question naire and examination . Patients with fibromyalgia were compared with  HIV-infected patients without fibromyalgia and with fibromyalgia patients without known risk factors for HIV infection . RESULTS Thirty-seven of 140 patients with HIV infection had muskuloskeletal symptoms . Three of these 37 patients had arthritis , but none had Reiter 's syndrome or psoriatic arthritis . Thirty ( 81 % ) of 37 patients had chronic musculoskeletal symptoms ( for 3 months or longer ) . Twenty of 30 patients with chronic musculoskeletal symptoms had polyarthralgia , and of those , 15 ( 75 % ) were found to have either definite or probable fibromyalgia syndrome . Therefore , fibromyalgia syndrome was found in 41 % of HIV-infected patients with musculoskeletal symptoms and in approximately 11 % of all HIV-infected patients . Fibromyalgia patients with HIV infection had a longer duration of HIV infection ( p = 0.01 ) and more frequently reported past depressed mood ( p = 0.001 ) than HIV-infected patients without fibromyalgia . Compared with 301 patients with fibromyalgia syndrome and no known risk behavior for HIV , known HIV-infected patients with fibromyalgia were more commonly male ( p = 0.001 ) and reported current depressed mood more frequently ( p = 0.0001 ) . CONCLUSION Few patients with arthritis were noted among HIV-infected patients who had intravenous drug use as risk behavior . By comparison , fibromyalgia syndrome appeared to be a common cause of musculoskeletal symptoms in this patient population Objectives : This study evaluated the prevalence and correlates of aberrant drug-taking behaviors in two population s : patients with HIV-related pain and a history of substance abuse ( n = 73 ) and patients with cancer pain and no history of substance abuse ( n = 100 ) . Methods : All patients completed a Drug-Taking Behaviors Interview , the Brief Symptom Inventory ( BSI ) , Brief Pain Inventory ( BPI ) , Memorial Symptom Assessment Scale ( MSAS )  , and the Marlowe Crowne Social Desirability Scale ( MCSDS ) .  The Pain Management Index was calculated to assess the adequacy of opioid prescribing . Results : The cancer sample comprised 38 men and 62 women , and the AIDS sample comprised 63 men and 10 women . Patients with AIDS-related pain had higher global distress on the MSAS ( F1 , 170 = 20.05 , P < 0.001 ) , greater pain-related interference in their daily functioning on the BPI ( F1 , 161 = 22.87 , P < 0.001 ) , and a lower percentage of relief from their current medications ( F1 , 156 = 76.14 , P < 0.001 ) . AIDS patients also reported more than twice as many examples of aberrant drug-related behaviors per patient ( mean = 6.14 , SD = 4.60 ) as the cancer patients ( mean = 1.42 , SD = 1.91 ) . Conclusion : These data suggest that AIDS patients with histories of substance abuse receiving opioid therapy are more symptomatic , have more distress , experience more interference from residual pain , and engage in more problematic drug-related behaviors than patients with no history of drug abuse receiving opioids for cancer pain . Treatment of substance abusers with pain requires skills that complement best practice s in opioid prescribing . Better approaches to the long-term treatment of these population s are needed We conducted a r and omized , double-blind , placebo-controlled , crossover study at a single center in South Africa , to ascertain whether amitriptyline is an effective analgesic for painful HIV-associated sensory neuropathy of moderate to severe intensity in : i ) antiretroviral drug naive individuals , and ii ) antiretroviral drug users . 124 HIV-infected participants ( antiretroviral drug naive = 62 , antiretroviral drug users = 62 ) who met the study criteria for painful HIV-associated sensory neuropathy were r and omized to once-daily oral amitriptyline ( titrated to a median : interquartile range of 50 : 25 - 50 mg ) or placebo for six weeks , followed by a three-week washout period and subsequent treatment crossover . The primary outcome measure was change from baseline in worst pain intensity of the feet ( measured by participant self-report using an 11-point numerical pain rating scale ) after six weeks of treatment . 122 of 124 participants completed all study visits and were included in the analysis of the primary outcome . In the antiretroviral drug-naive group ( n = 61 ) there was no significant difference in the mean change in pain score from baseline after six weeks of treatment with placebo or amitriptyline [ amitriptyline : 2.8 ( SD 3.3 ) vs. placebo : 2.8 ( 3.4 ) ] . Similarly , there was no significant difference in the change in pain score after six weeks of treatment with placebo or amitriptyline in the antiretroviral drug-user group ( n = 61 ) [ amitriptyline : 2.7 ( 3.3 ) vs. placebo : 2.1 ( 2.8 ) ] . Controlling for period effects and treatment order effects did not alter the outcome of the analyses . Nor did analyzing the intention-to-treat cohort ( missing data interpolated using baseline observation carried forward ) alter the outcome of the analyses . In summary , amitriptyline , at the doses used here , was no more effective than an inactive placebo at reducing pain intensity in individuals with painful HIV-associated sensory neuropathy of moderate to severe intensity , irrespective of whether they were on antiretroviral therapy or not . Trial Registration IS RCT N OBJECTIVE To provide up date d estimates of the prevalence and clinical impact of human immunodeficiency virus-associated sensory neuropathy ( HIV-SN ) and neuropathic pain due to HIV-SN in the combination antiretroviral therapy ( CART ) era . DESIGN Prospect i ve , cross-sectional analysis . Clinical correlates for HIV-SN and neuropathic pain , including age , exposure to CART , CD4 levels , plasma viral load , hepatitis C virus infection , and alcohol use disorders , were evaluated in univariate and multivariate models . SETTING Six US academic medical centers . PATIENTS One thous and five hundred thirty-nine HIV-infected individuals enrolled in the CNS ( Central Nervous System ) HIV Anti-Retroviral Therapy Effects Research study . MAIN OUTCOME MEASURES The presence of HIV-SN , defined by 1 or more clinical signs ( diminished vibration or sharp sensation in the legs and feet ; reduced ankle reflexes ) in a distal , symmetrical pattern . Neuropathic pain was defined as aching , stabbing , or burning in a similar distribution . The effect on quality of life was assessed with the Medical Outcomes Study HIV Health Survey . RESULTS We found  HIV-SN in 881 participants . Of these , 38.0 % reported  neuropathic pain . Neuropathic pain was significantly associated with disability in daily activities , unemployment , and reduced quality of life . Risk factors for HIV-SN after adjustment were advancing age ( odds ratio , 2.1 [ 95 % confidence interval , 1.8 - 2.5 ] per 10 years ) , lower CD4 nadir ( 1.2 [ 1.1 - 1.2 ] per 100-cell decrease ) , current CART use ( 1.6 [ 1.3 - 2.8 ] ) , and past " D-drug " use ( specific dideoxynucleoside analogue antiretrovirals ) ( 2.0 [ 1.3 - 2.6 ] ) . Risk factors for neuropathic pain were past D-drug use and higher CD4 nadir . CONCLUSIONS Neuropathic pain and HIV-SN remain prevalent , causing substantial disability and reduced quality of life even with successful CART . The clinical correlates of HIV-SN have changed with the evolution of treatment . These findings argue for redoubled efforts to determine HIV-SN pathogenesis and the development of symptomatic and neuroregenerative therapies & NA ; This r and omized , placebo‐controlled trial and open‐label extension study of pregabalin for the treatment of human immunodeficiency virus – associated distal sensory polyneuropathy did not demonstrate significant effects of pregabalin . & NA ; The objective of these studies was to assess the efficacy and safety  of pregabalin in the treatment of human immunodeficiency virus (HIV)–associated neuropathic pain . Patients with HIV‐associated distal sensory polyneuropathy ( DSP ) were r and omized to treatment with flexible‐dose pregabalin ( 150–600 mg/day ) or placebo for 17 weeks in a single‐blind , placebo lead‐in , r and omized , double‐blind , parallel‐group , placebo‐controlled multinational trial . The primary efficacy outcome was the change in mean pain score on an 11‐point numeric rating scale ( NRS ) from baseline to study endpoint . Participants who completed this trial were invited to participate in a 6‐month open‐label extension study with pregabalin . Of the 377 patients enrolled in the r and omized controlled trial ( pregabalin , n = 183 ; placebo , n = 194 ) , 68.4 % completed treatment . In the open‐label extension , 217 patients were treated and 59.4 % completed treatment . Both studies were terminated by the sponsor after a preplanned interim analysis indicated trial futility . At endpoint , the change from baseline in least‐squares mean NRS pain scores in the intent‐to‐treat population was −2.04 for pregabalin versus −2.11 for placebo ( P = .709 ) . There were no significant differences between the pregabalin and placebo groups in the secondary efficacy measures . Incidence of adverse events was lower than seen in previous pregabalin studies . Overall , this trial did not show pregabalin to be more efficacious  than placebo in treating HIV‐associated DSP . Studies such as these , which fail to support their primary hypotheses , may be important in informing the methodology of future trials , especially when novel approaches to limit variability in the control group are included . Clinical Trials.gov identifiers : NCT0104 
    Output:
    
“ Some ” or “ moderate ” evidence supported an association between pain outcomes in people with HIV and the following psychosocial factors : depression , psychological distress , posttraumatic stress , drug abuse , sleep disturbance , reduced antiretroviral adherence , health care use , missed HIV clinic visits , unemployment , and protective psychological factors .