Pain and distress are frequently reported by people with HIV. Although pain is widely acknowledged to contribute to distress, distress may also contribute to pain and its persistence. Given the evidence supporting a relationship between distress and clinical pain, the current study investigated the relationships between distress, secondary hyperalgesia (SH), and persistent pain. We anticipated that SH is an important link between distress and persistent pain, with distress potentially exacerbating pain by increasing the responsiveness of neurons in the central nervous system to nociceptive signalling. Our primary hypothesis was that self-reported distress would be positively associated with the induced surface area (primary measure) and magnitude (secondary measure) of SH. The secondary hypothesis was that individuals with persistent pain would display greater induced SH compared to those who reported being pain-free. The results showed that distress was positively associated with the surface area and the magnitude of induced SH. However, participants with persistent pain showed no difference in the surface area of SH compared to pain-free participants, and those with pain displayed a marginally lower magnitude of SH. These findings suggest that distress may be a worthy target of interventions in people exposed to acutely painful events. While this relationship may not be specific to people with HIV, further research is needed to establish its relevance to people without HIV.

GJB receives speakers' fees for talks on pain and rehabilitation. MRH receives payments from the Department of Education and Department of Science, Industry and Resources; serves as the Chair of the Safeguarding Australia through Biotechnology Response and Engagement Alliance steering committee and the Australian Pain Solutions Research Alliance board; and is a Member of the Prime Minister's National Science and Technology Council. JAJ has received consultancy fees for research from the University of Maryland and the University of Bern. RP receives payment for lectures on pain and rehabilitation and is an unpaid director of the not-for-profit organisation, Train Pain Academy. VJM also receives payment for lectures on pain and rehabilitation and is an unpaid associate director of the not-for-profit organisation, Train Pain Academy. All other authors declare no conflicts of interest related to this work.

NCT04757987

https://bmjopen.bmj.com/content/12/6/e059723

This work was funded by NIH award K43TW011442 to VJM. LM received financial support through a postgraduate scholarship from the University of Cape Town and the National Research Foundation (NRF South Africa). GJB was supported by postgraduate scholarships from PainSA, the NRF, and the Oppenheimer Memorial Trust. MRH receives funding from the Australian Research Council, the National Health and Medical Research Council, and the Defence Science and Technology Group. RRE is partially supported by NIH Award K24 NS126570.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee of Faculty of Health Sciences of the University of Cape Town gave ethical approval for this work. Local health authority of the City of Cape Town gave ethical approval for this work

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The de-identified study data are available for selective sharing, subject to review of individual data requests, the use of secure computer platforms, formal use agreements, and compliance with the institutional human research ethics policies. Data use is limited to research purposes, on secure computer servers. The principal investigator (VJM) is the contact person for requests to share data.

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