Lower extremity splinting to manage pain and sleep disturbances associated with HIV/AIDS related peripheral neuropathy
BACKGROUND: Pain, sleep and functional disturbances are a common occurrence in people living with HIV/AIDS-related distal sensory peripheral neuropathy (PLWHA-DSPN), yet lack group classification and quantification. DSPN-pain is predominantly managed by using systemic agents with little evidence supporting their analgesic efficacy. Animal models suggest the presence of analgesic effects associated with immobilization. The purpose of this study is to evaluate the effect of nighttime lower extremity splinting application on DSPN-related pain and sleep disturbances compared to a splint liner application. METHODS: Forty-six PLWHA-DSPN were recruited, as part of a two-group intervention study, to complete the Neuropathic Pain Scale (NPS) and The Pittsburgh Sleep Quality Index (PSQI) questionnaires. The participant's performance during a forward reach task and walking distance in six minutes was recorded as a measure of function. For the intervention study, pain and sleep outcomes were measured at baseline, week three and six. The pain outcome was measured using the NPS and the sleep outcome using the PSQI. RESULTS: The baseline pain (60.77±17.85) and sleep (14.62±4.28) scores denote marked pain and sleep disturbances, compared to seronegative age-matched individuals. The ambulation distance was limited (243.99±141.04 m), and inversely associated with the PSQI-sleep efficiency subscale (rs=-0.35, p<0.05). The average reaching distances measured at baseline (36.07±7.37 cm) were similar to seronegative age-matched individuals. Pain, sleep, and functional measures exhibited significant associations. Pain and sleep scores improved in both intervention groups over time. The median percentage pain reduction at week six was 8% in the liner group and 34% in the splint group. The change in pain scores in the splint group was found to be significant over time, p<0.0005. The contrast between the splint and liner groups was underpowered (26%) and was not found to be significant, p>0.05. Sleep scores improved 20% from baseline to the end of the study in both groups; all participants were classified as poor sleepers. CONCLUSIONS: The data collected suggest that PLWHA-DSPN report moderate to severe pain, significant sleep disturbances and limited ambulation distances. The six-week use of nighttime splints reduces DSPN-pain. Future studies are needed to validate effective this non-pharmacological intervention to manage HIV-related DSPN pain.