Chronic Pain in HIV

Publication Date: October 30, 2017

Key Points

Key Points

Chronic pain remains a significant problem in persons living with HIV (PLWH) and is associated with psychological and functional morbidity, even in the absence of advanced disease complications. Depending upon the study, current prevalence estimates of chronic pain in PLWH ranges from 39%–85%.

Nearly half of that pain is neuropathic, due to injury to the central or peripheral nervous systems from direct viral infection, infection with secondary pathogens, or side effects of medications.

Non-neuropathic pain, such as nociceptive pain, in PLWH is caused by tissue injury as a result of inflammation (e.g., autoimmune responses), infection (e.g., bacteria, other viruses, tuberculosis), or neoplasia (e.g., lymphoma or sarcoma).

Diagnosis

...Diagnosis...

...Screen...

All persons living with HIV should rec...

...ersons who screen positive for chronic...

...roviders should monitor the treatmen...


Treatment

...Treat...

...Management

...medical providers should develop and participate...

For patients whose chronic pain is control...

...persons living with HIV age, their pai...

...ritical to maintaining pain control, it i...

...ultation with a palliative care spe...

...with advanced illness require a sup...


...Non...

...avioral therapy (CBT) is recommended...

...ommended for the treatment of chronic neck/...

...and occupational therapy is recommended for...

...ecommended for neuropathic pain. ( S , L)705...

...t consider a trial of acupuncture for chronic...


...Pharmacologic...

...Non-Opioids...

Early initiation of anti-retroviral...

...apentin is recommended as a first line oral pharma...

Remark: A typical adult regimen wil...

...If patients have an inadequate response to gaba...

...If patients have an inadequate response to gaba...

...atients have an inadequate response to...

...apsaicin is recommended as a topic...

Remark: A single 30-minute application...

Medical cannabis may be an effective t...

...commends alpha lipoic acid (ALA) for the manageme...

...DSA recommends against using lamotrigine t...

...Opioids

...s living with HIV, opioid analgesics should...

...y consider a time-limited trial of opioid...


...Pharma...

...Non-Opioids...

...nophen and NSAIDS are recommended as first-li...

...Opioids...

...ents who do not respond to first lin...

...ken up to three months may decrease pain, improve...

...Conseq...

...ibers should assess all patients for the poss...

Routine monitoring of patients prescribed opioid a...

...n “opioid patient-prescriber agreement”...

...should understand the clinical uses and limitatio...

...stances should be stored safely aw...

...ould teach patients and their caregivers abou...

...ient education is recommended to help...

...d be knowledgeable about common pharmac...

...uld follow patients closely when int...

...ons with a history of a substance u...

...th a history of addiction for whom the...

...Methadone

...d release of information to exchange...

...tial screening with ECG to identify...

...he splitting of methadone into 6–8 hour dos...

...me OTPs may be able to offer a split-dose methado...

...additional methadone is not possible...

...exacerbations in pain or “breakthrough...

...Buprenorphine...

...should utilize adjuvant therapy appropriate t...

...rt opinion, the clinician should increase the...

...n expert opinion, clinician’s might switch from...

...ends, if a maximal dose of buprenorphin...

...ses of an additional opioid are ineffective f...

For patients on buprenorphine maintenanc...


...Mental Health Disorde...

...ans should fully review a patient...

...ll patients should be screened for...

...questionnaire in the public domain, is r...

...ents should be screened for co-morbi...

...ended that all patients with chronic pain have a...

...//www.integration.samhsa.gov/images/r...