Opioid misuse and perceived smoking-pain relationships among HIV+ individuals with pain: Exploring negative affect responses to pain. 
Persons living with HIV/AIDS (PLWHA) report high rates of clinically significant pain that is associated with several negative outcomes, including higher CD4 T-cell count, poor medication adherence, and substance use and misuse.  Importantly, PLWHA also report elevated rates of both opioid and tobacco use, and these elevated rates have often been associated with increased pain experience.  Although research suggests that negative affective responses to pain may be uniquely associated with substance misuse among individuals in the general population, little work has examined these relations among PLWHA.  The current study examined negative emotions in response to pain as a predictor of current opioid misuse, future opioid misuse, and perceived smoking-pain relationships among 66 (Mage = 51.26, SD = 8.00, 60.6% male) HIV+ adults with co-occurring pain.  Results indicated that negative emotions in response to pain uniquely predicted each of the substance use outcomes, with clinically significant effect sizes that may be characterized as medium in magnitude.  Overall, these findings suggest that negative affective responses to pain may play a role in prescription opioid misuse and smoking among PLWHA.  These findings may inform the development of tailored interventions for PLWHA smokers who are prescribed opioid pain medications.