Neuropathic Pain Etiology Leads to Variable Health-Related Quality of Life Measures

sick woman in hospital
sick woman in hospital
One aim of this study was to compare breast cancer survivors and HIV patients, both with neuropathic pain, with regard to psychological factors and health-related quality of life.

Health-related quality of life differs significantly according to the etiology of a patient’s neuropathic pain, according to research results published in the Scandinavian Journal of Pain.

Researchers sought to compare 2 groups of patients with neuropathic pain from differing etiologies — postsurgical breast cancer patients and people with HIV with sensory neuropathy — in order to evaluate health-related quality of life outcomes and the potentially different patterns in personality, mood, and/or pain-related catastrophizing in these groups.

Additionally, researchers wanted to evaluate whether these groups had differing psychological factors that accounted for health-related quality of life and pain interference measures.

Women with breast cancer (n=89) were recruited from a study of 1000 women treated at Helsinki University Hospital between 2006 and 2010. Patients with HIV (n=73; 64 men) were recruited from outpatient clinics associated with the United Kingdom’s Chelsea and Westminster Hospital NHS Foundation Trust and through national HIV charities between 2014 and 2017. All participants completed questionnaires about baseline demographic information and numerous questionnaires and interviews on pain and quality of life.

Questionnaire results demonstrated that patients with HIV reported a significantly higher presence of depressive symptoms, anxiety, pain catastrophizing, and insomnia, as well as lower scores for agreeableness, emotional stability, and extroversion. These patients also experienced higher pain intensity and interference. The mean Douleur Neuropathique 4 interview part (DN4i) score was higher in the HIV cohort compared with the breast cancer cohort (4.9±1.2 vs 4.1±0.95, respectively).

Analyses of covariance (ANCOVA) were performed, allowing researchers to control for pain intensity in group comparisons; these differences remained significant with covariates across the model.

Patients in the HIV cohort also experienced lower mental and physical health-related quality of life scores compared with the breast cancer cohort. Additionally, researchers noted a positive correlation between anxiety and catastrophizing in the HIV group (R2=0.41; 95% CI, 0.20-0.58 vs R2, 0.14; 95% CI, -0.07 to 0.34).

Mood, measured via total Hospital Anxiety and Depression Scale (HADS) score, was negatively associated with mental quality of life across both groups, with similar HADS regression coefficients in both groups (b= -0.580 and -0.591, respectively).

Lower pain interference was associated with a better mental quality of life in the HIV group (b= -0.344) while higher extraversion and a lower number of symptoms in the breast cancer group was associated with a better mental quality of life (b=0.299 and b=–0.154, respectively).

In both groups, younger age was associated with better physical quality of life and with better mood in the HIV cohort; however, higher pain catastrophizing was associated with lower physical quality of life in the breast cancer cohort.

Study limitations include the small size of each cohort, the cross-sectional nature of the study, and researchers’ inability to draw conclusions on whether the primary disease or treatments (antiretroviral therapy and chemotherapy, respectively) have changed either personalities or catastrophizing tendencies in 2 “very different patient cohorts.”

Future research that includes a questionnaire focused on patient experiences with stigma could provide more insight into differences between the cohorts.

“Pain interference and [health-related quality of life] showed similar negative associations in the groups,” the researchers concluded. “The burden of disease may bring more challenge to treatment interventions. Targeted interventions to treat specific symptoms e.g. pain acceptance, sleep interventions, and active coping may be of importance.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Sipilä R, Kemp H, Harno H, Rice ASC, Kalso E. Health-related quality of life and pain interference in two patient cohorts with neuropathic pain: breast cancer survivors and HIV patients. Scand J Pain. Published online March 16, 2021. doi:10.1515/sjpain-2020-0177

This article originally appeared on Clinical Pain Advisor