Browsing by Author "Merlin, Jessica S."
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Item Author Response to Reader's Comments to Fitzgerald Jones et al., Top Ten Tips Palliative Care Clinicians Should Know About Delivering Antiracist Care to Black Americans (DOI: 10.1089/jpm.2021.0502)(Mary Ann Liebert, 2022) Jones, Katie Fitzgerald; Laury, Esther; Sanders, Justin; Starr, Lauren T.; Rosa, William E.; Booker, Staja Q.; Wachterman, Melissa; Jones, Christopher A.; Hickman, Susan; Merlin, Jessica S.; Meghani, Salimah H.; School of NursingItem Brief Report: IL-1β Levels Are Associated With Chronic Multisite Pain in People Living With HIV(Wolters Kluwer, 2017-08-01) Merlin, Jessica S.; Westfall, Andrew O.; Heath, Sonya L.; Goodin, Burel R.; Stewart, Jesse C.; Sorge, Robert E.; Younger, Jarred; Psychology, School of ScienceBACKGROUND: The pathophysiology of chronic pain experienced by people living with HIV (PLWH) in the current antiretroviral treatment era is poorly understood. We sought to investigate the relationship between inflammation and chronic pain in PLWH. We hypothesized that, among PLWH who have undetectable HIV viral loads, those with chronic multisite pain (CMP) would have higher levels of circulating pain-related inflammatory markers than those without chronic pain. SETTING: This study was conducted at the University of Alabama at Birmingham's Center for AIDS Research Network of Integrated Clinical System site. METHODS: We compared inflammatory markers in 70 PLWH with CMP and 70 PLWH without chronic pain. Custom multiplex human inflammatory assays were completed on banked plasma specimens to measure cytokines commonly associated with chronic inflammatory pain: interleukin 1β (IL-1β), eotaxin, IL-15, IL-6, tumor necrosis factor α, and leptin. Logistic regression models were built using group status (CMP vs no pain) as the outcome variable, with each cytokine as independent variables and age, sex, substance use, and prescribed opioid medications as covariates. RESULTS: Participants were mostly men (71%); 53% were 50 years or older. The most common sites of pain were low back (86%), hands/feet (81%), and knee (66%). Median CD4 T-cell count was 676 cells per milliliter. IL-1β was significantly higher in the CMP group than in the individuals without chronic pain (odds ratio: 1.35, 95% confidence interval: 1.01 to 1.82, P < 0.05). Eotaxin, IL-15, IL-6, tumor necrosis factor α, and leptin were not significantly different between groups. CONCLUSIONS: We found that PLWH who also have CMP have significantly higher levels of IL-1β than PLWH who do not have any pain. Future work on the role of IL-1β on chronic pain pathogenesis in this population may inform novel approaches to chronic pain management.Item Cost-effectiveness of a chronic pain intervention for people living with HIV (PLWH)(Taylor & Francis, 2018) Merlin, Jessica S.; Westfall, Andrew O.; Johnson, Mallory O.; Kerns, Robert D.; Bair, Matthew J.; Kertesz, Stefan; Turan, Janet M.; Clay, Olivio J.; Starrels, Joanna L.; Kilgore, Meredith; Medicine, School of MedicineBackground: Chronic pain is a common, disabling, and costly comorbidity, particularly in people living with HIV (PLWH). This study developed and pilot tested a pain self-management intervention for chronic pain tailored to PLWH called Skills TO Manage Pain (STOMP). Objectives: Given the additional resources needed to deliver STOMP in HIV clinical settings, an important objective of the pilot study was to assess not only STOMP’s preliminary efficacy, but also its cost-effectiveness. Research design and subjects: The present study draws from a 44-participant, 2-arm randomized pilot trial of the STOMP intervention vs usual care among PLWH and at least moderate chronic pain (Clinicaltrials.gov: NCT02824562). Cost-effectiveness is presented as the incremental cost-effectiveness ratio (ICER). Costs were considered from the clinic perspective over a 1-year time horizon using real costs from the pilot trial. It was conservatively assumed there would be no costs savings. The Standard Gamble (SG) method was used to directly measure utilities. Results: Thirty-six participants met inclusion criteria for the present analyses. Mean age was 52 years; 61% were female and 86% were black. The total cost of STOMP was $483.83 per person. Using the SG method, the change in QALYs was 0.15, corresponding to an ICER of $3,225. Conclusions: STOMP’s cost/QALY is substantially lower than the $50,000 to $100,000/QALY benchmark often used to indicate cost-effectiveness. Although based on a pilot trial and, therefore, preliminary, these findings are promising, and suggest the importance of cost analyses in future STOMP trials.Item Intervention Mapping to develop a Social Cognitive Theory-based intervention for chronic pain tailored to individuals with HIV(Elsevier, 2018-02-19) Merlin, Jessica S.; Young, Sarah R.; Johnson, Mallory O.; Saag, Michael; Demonte, William; Kerns, Robert; Bair, Matthew J.; Kertesz, Stefan; Turan, Janet M.; Kilgore, Meredith; Clay, Olivio J.; Pekmezi, Dorothy; Davies, Susan; Medicine, School of MedicineChronic pain is an important comorbidity among individuals with HIV. Behavioral interventions are widely regarded as evidence-based, efficacious non-pharmacologic interventions for chronic pain in the general population. An accepted principle in behavioral science is that theory-based, systematically-developed behavioral interventions tailored to the unique needs of a target population are most likely to be efficacious. Our aim was to use Intervention Mapping to systematically develop a Social Cognitive Theory (SCT)-based intervention for chronic pain tailored to individuals with HIV that will improve pain intensity and pain-related functional impairment. Our Intervention Mapping process was informed by qualitative inquiry of 24 patients and seven providers in an HIV primary care clinic. The resulting intervention includes group and one-on-one sessions and peer and staff interventionists. We also developed a conceptual framework that integrates our qualitative findings with SCT-based theoretical constructs. Using this conceptual framework as a guide, our future work will investigate the intervention's impact on chronic pain outcomes, as well as our hypothesized proximal mediators of the intervention's effect.Item Pain self-management in HIV-infected individuals with chronic pain: a qualitative study(Wiley Blackwell (Blackwell Publishing), 2015-04) Merlin, Jessica S.; Walcott, Melonie; Kerns, Robert; Bair, Matthew J.; Burgio, Kathryn L.; Turan, Janet M.; Department of Medicine, IU School of MedicineOBJECTIVE: Chronic pain in individuals with HIV is a common, impairing condition. Behavioral interventions for chronic pain specifically tailored to this population have yet to be developed. We assert that understanding self-management strategies already used by persons living with these conditions is an essential first step, and is the objective of this investigation. DESIGN: We conducted a thematic analysis of qualitative data from 25 in-depth interviews with individuals with HIV and chronic pain. RESULTS: The primary pain self-management strategies articulated by participants were: physical activity; cognitive and spiritual strategies; spending time with family and friends and social support; avoidance of physical/social activity; medication-centric pain management; and substance use. CONCLUSIONS: Some of these strategies may be viewed as beneficial and overlap with known HIV self-management strategies (cognitive strategies), whereas others may have negative health consequences (substance use). Interventions that incorporate healthy self-management strategies may be particularly effective in improving both HIV and pain outcomes.Item A Randomized Pilot Trial of a Novel Behavioral Intervention for Chronic Pain Tailored to Individuals with HIV(Springer Nature, 2018-08) Merlin, Jessica S.; Westfall, Andrew O.; Long, Dustin; Davies, Susan; Saag, Michael; Demonte, William; Young, Sarah; Kerns, Robert D.; Bair, Matthew J.; Kertesz, Stefan; Turan, Janet M.; Kilgore, Meredith; Clay, Olivio J.; Starrels, Joanna; Pekmezi, Dorothy; Johnson, Mallory O.; Medicine, School of MedicineChronic pain is an important and understudied comorbidity in people living with HIV (PLWH). We conducted a pilot trial of Skills TO Manage Pain (STOMP), an innovative social cognitive theory-based pain self-management intervention tailored to PLWH, to assess feasibility, acceptability, and preliminary efficacy. Eligibility criteria included being HIV+, ≥ moderate pain for ≥ 3 months and a score of ≥ 4 on the three-item PEG pain severity and interference scale. Participants were randomized in a 1:1 fashion to STOMP or a usual care comparison. Among 22 participants randomized to STOMP, median session attendance was 9/12 (75%). Of 19 STOMP participants surveyed, 13 reported being "much better" overall since beginning treatment. Brief pain inventory-total scores decreased by 2 points in the intervention group and 0.9 in the control group (p = 0.11). STOMP is feasible, acceptable, and shows preliminary evidence of efficacy and promise for a full-scale trial.Item Top Ten Tips Palliative Care Clinicians Should Know About Delivering Antiracist Care to Black Americans(Mary Ann Liebert, 2022) Jones, Katie Fitzgerald; Laury, Esther; Sanders, Justin J.; Starr, Lauren T.; Rosa, William E.; Booker, Staja Q.; Wachterman, Melissa; Jones, Christopher A.; Hickman, Susan; Merlin, Jessica S.; Meghani, Salimah H.; School of NursingRacial disparities, including decreased hospice utilization, lower quality symptom management, and poor-quality end-of-life care have been well documented in Black Americans. Improving health equity and access to high-quality serious illness care is a national palliative care (PC) priority. Accomplishing these goals requires clinician reflection, engagement, and large-scale change in clinical practice and health-related policies. In this article, we provide an overview of key concepts that underpin racism in health care, discuss common serious illness disparities in Black Americans, and propose steps to promote the delivery of antiracist PC.Item Using Patient Perspectives to Inform the Development of a Behavioral Intervention for Chronic Pain in Patients with HIV: A Qualitative Study(Oxford University Press, 2017-05-01) Merlin, Jessica S.; Young, Sarah R.; Johnson, Mallory O.; Saag, Michael; Demonte, William; Modi, Riddhi; Shurbaji, Sally; Anderson, William A.; Kerns, Robert; Bair, Matthew J.; Kertesz, Stefan; Davies, Susan; Turan, Janet M.; Medicine, School of MedicineBackground: Chronic pain is a common and disabling comorbidity in individuals living with HIV. Behavioral interventions are among the most effective and safe nonpharmacologic treatments for chronic pain. However, the success of a behavioral intervention is influenced by how well it is tailored to the target population's biological, psychological, and social context. Given well-documented psychosocial vulnerabilities among persons with HIV, it is critical to develop a behavioral intervention for chronic pain tailored to this population. Objective: To use qualitative methods to investigate patient preferences for the structure and delivery of a behavioral intervention for chronic pain in individuals with HIV. Methods: Interviews and focus groups were used to elicit participant preferences. A thematic analysis approach, with an initial round of open coding, was used to develop the codebook and analyze the data. Results: Qualitative data from 12 interviews and 3 focus groups with patients living with HIV and chronic pain (total N = 24) were analyzed. Emergent themes fell into four major categories: perceived value of group sessions, incorporating peer leadership, and two key elements of how the intervention should be delivered: the HIV status of group participants and views on phone-delivered intervention content. Discussion: This study provides a framework for the structure and delivery of a behavioral intervention for chronic pain in individuals with HIV based on patient preferences. We will use these results to design our intervention, and hope that our approach informs the work of investigators in other disciplines who seek to incorporate patient preferences during intervention development.