The Impact of Insomnia on Pain in HIV

TNF-a, IL-6, IL-12, IL-18, C-reactive protein, sCD14/163, D-dimer and IFN-gamma assays will be performed on the blood to identify levels of pro-inflammatory markers.

IFN-a, TGF-B, IL4, IL-10 and IL-13 assays will be performed on the blood to identify levels of anti-inflammatory markers.

Mitochondrial DNA damage, Damage associated molecular patterns (DAMPS) and Cortisolassays will be performed on the blood to identify levels of anti-inflammatory markers.

Pain threshold refers to the intensity at which a stimulus is first perceived as painful. Heat stimuli will be delivered using a computer-controlled thermal stimulation system with a 30 millimeter X 30 millimeter probe. From a baseline of 32 degrees Celsius, the probe temperature will increase at a rate of .5 degrees Celsius/second until the participant responds by pressing a button on a handheld device. For heat pain threshold, participants will be instructed to press the button when the sensation "first becomes painful"

Pain tolerance refers to the maximum amount of pain produced by a stimulus that a person is able/willing to tolerate. Heat stimuli will again be delivered using the computer-controlled thermal stimulation system. From a baseline of 32 degrees Celsius, the probe temperature will increase at a rate of .5 degrees Celsius/second until the participant responds by pressing a button on a handheld device. For heat pain tolerance, participants will be instructed to press the button when they are "no longer willing to tolerate" the painful sensation.

Monofilament touch test refers to the maximum amount of pain produced by a stimulus that a person is able/willing to tolerate. Participants will be asked to rate their pain after being stimulated either once or ten times with vonfrey filament, or until they can no longer tolerate" the painful sensation.

Temporal summation of pain refers to a form of endogenous pain facilitation characterized by the perception of increased pain despite constant or even reduced peripheral afferent input. Temporal summation is presumed to be the psychophysical manifestation of wind-up. Wind-up is a phenomenon where repetitive stimulation of C primary afferents at rates greater than 0.3 Hertz produces a slowly increasing response of second-order neurons in the spinal cord. A series of 5 heat pulses will be repeated every two seconds starting at a baseline temperature of 40 and participants will be asked to rate how painful each peak of the pulse feels to them using a pain rating of 0-100 (0 no pain at all to 100 the most intense pain imaginable). These heat pulses will be repeated randomly at three different temperatures peaking at 44, 46, and 48 degrees in Celsius.

A routinely used quantitative sensory testing protocol for the measurement of endogenous pain inhibition, which refers to the reduction in pain from one stimulus (the test stimulus) produced by the application of a second pain stimulus (the conditioning stimulus). The conditioning stimulus will be the cold pressor task (Thermo Scientific) applied to the non-dominant hand. For this procedure the cold water will be maintained at 10C and participants will keep their hand immersed for 60 seconds. Upon removal of the hand, a mechanical pressure stimulus will be applied. The pressure stimulus used is a handheld, digital pressure algometer (Algomed, Medoc, Ramat Yishai, Israel) to assess pressure pain applied to the dominant forearm and ipsilateral trapezius by gradually increasing pressure at a rate of 30 kiloPascals (maximum 1000 kiloPascals) per second until participants indicate when the increasing pressure first becomes painful by pressing a button on a device they will be holding.

A light weight and compact watch-like device used for objective measurement of sleep. The device will be worn for 7 consecutive days/nights and will track physical activity, falling asleep and waking events, and includes an integrated light sensor for recording photopic light.

A sleep diary including 15 daily questions will be filled out every day for seven days including questions about a participants nightly sleep experiences.

A caffeine dairy including different types of caffeine generally available for the participants to record their daily caffeine consumption of for seven days.

The SPPB consists of 3 individual sub-tests - standing balance (participants are asked to stand in 3 easy stances for 10 seconds), 4-meter gait speed (participants are asked to walk a steady pace in a straight line for 4-meters) and 5-repetition sit-to-stand (particpants are asked to stand up and sit back down in a stable chair up to 5 times). All 3 are simple and quick to perform in the outpatient setting and require only limited equipment; participants are asked to rate difficulty 0-100 (0 no difficulty and 100 being the most difficult imaginable) and pain 0-100 (0 no pain and 100 being the most pain imaginable).

The Timed Up and Go test (TUG) is a commonly used screening tool to assist clinicians to identify patients at risk of falling. Participants are asked to start in a sitting position in a chair, stand up and walk approximately 3 meters before turning to return to the chair at a steady, straight pace. The outcome will be measured with a stopwatch, then rating difficulty 0-100 (0 no difficulty and 100 being the most difficult imaginable) and pain 0-100 (0 no pain and 100 being the most pain imaginable).

Consisting of 19 questions, this is a self-reported scale that is used to assess the midpoint of everyday wake and sleep schedules, as well as assessing an individual's chronotypes.

Using a 5-point scale and 7 questions, the ISI has each participant subjectively measure their insomnia severity.

This questionnaire better helps the investigators understand how each participant's financial, racial, social, etc. background. It ranges from general questions such as age and birthday, to socioeconomic questions such as work status and financial stability.

By specifically asking about the past week, this questionnaire seeks to gain a better understanding of each participant's state of mind in reference to depressive behaviors and/or feelings.

Sleep is a key aspect in an individual's everyday life. This questionnaire measures overall sleep quality in six different categories---Regularity, Sleep quality, alertness, timing, efficiency, and duration. This helps investigators understand a person's sleep efficacy.

The main goal of this questionnaire is to assess and individual's overall health status/condition. It asks questions about a person's physical well-being, and aims to identify any illnesses they may be suffering from.

This questionnaire aims to subjectively measure the different emotions a person may be feeling, and how difficult it may be for a person to regulate those emotions.

This questionnaire measures various sleep related attitudes and assesses beliefs about sleep that are related to insomnia.

This questionnaire seeks to understand how pain has an influence/impacts an individual's everyday life and activities, sleep, and mood in general.

Tcord provides individuals with the space to write down what they've eaten in the past 24 hours, as well as what time, where they ate it, and about how much they think that they ate.

This questionnaire asks about a person's general diet and intake.

This drug screening asks questions related to the consequences of drug abuse and the problems associated with it.

This psychological questionnaire aims to measure the intensity of anxiety. It seeks to separate the state anxiety (temporary) from trait anxiety (general), as well as general anxiety and depressive feelings.

Seeks to measure the level of addiction/dependence on smoking cigarettes.

Seeks to measure the level of addiction/dependence on smoking electronic cigarettes.

This questionnaire assesses alcohol consumption as well as related problems and behaviors.

This questionnaire detects and measures substance abuse, alcohol, and smoking as well as related problems. It aims to detect the risky behavior related to each.

This questionnaire measures emotions, primarily anger, relevant to the past 7 days.

This 14 -item self-report scale measures the degree to which an individual perceives the amount of stress in their lives.

This is a subjective look into how catastrophizing impacts an individual's pain. Specifically, it aims to measure catastrophic thinking related to pain they experience during the experimental session.

This questionnaire aims to see how an individual internalizes their experiences with HIV. Further, it asks about the negative feelings related and the beliefs associated with HIV.

Measures the different ways people anticipate experiencing discrimination in their everyday life by asking them to rate 4 items that describe how they prepare to face day to day discrimination (scale 1-6; 1 almost every day, 6 never).

This scale evaluates each individual's experiences of discrimination. By providing a list of reasons a person may be discriminated against, it aims to see how each individual perceives their experiences.

This questionnaire scores on a 10 point scale, and asks about childhood experiences in reference to abuse and neglect.

This 0-10 rating scale aims to assess fatigue and energy over time.