Chronic Pain in HIV
Key Points
Key Points
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
...and Initial Assessment...
...l persons living with HIV should rece...
...screen positive for chronic pain, an initial...
...edical providers should monitor the trea...
Treatment
...atment...
...anagement
...oviders should develop and participate in i...
...or patients whose chronic pain is control...
...ving with HIV age, their pain experience may...
...to maintaining pain control, it is recomm...
...on with a palliative care specialist to a...
...tients with advanced illness require a su...
...-Pharmacological Treatments...
...vioral therapy (CBT) is recommended...
...recommended for the treatment of chronic neck...
Physical and occupational therapy is recomm...
...pnosis is recommended for neuropathic pain. ( S...
...ans might consider a trial of acupuncture for chro...
...acological Treatments For Neuropathic Pain...
Non-Opioi...
...iation of anti-retroviral therapy (ART) is reco...
...tin is recommended as a first line oral pha...
...k: A typical adult regimen will titrate...
...s have an inadequate response to gabapen...
...have an inadequate response to gabapentin,...
...f patients have an inadequate response to gaba...
...s recommended as a topical treatment for the...
...rk: A single 30-minute application of...
...annabis may be an effective treatm...
...ommends alpha lipoic acid (ALA) for the manage...
...recommends against using lamotrigine...
...ioids...
...persons living with HIV, opioid ana...
...ians may consider a time-limited trial of o...
...cal Treatments For Non-Neuropathic Pain...
...n-Opioids...
Acetaminophen and NSAIDS are recommended as first-...
...pioid...
...who do not respond to first line therapies a...
...aken up to three months may decrea...
...ces of Opioid Treatment (e.g., misuse, substanc...
...s should assess all patients for the possib...
...e monitoring of patients prescribed op...
An “opioid patient-prescriber ag...
...r should understand the clinical uses and limitat...
...stances should be stored safely away from...
...ns should teach patients and their care...
...n is recommended to help patients avoid adverse e...
...viders should be knowledgeable about comm...
...should follow patients closely when in...
...rsons with a history of a substance use...
...ns with a history of addiction for whom...
Methado...
...igned release of information to exchang...
...screening with ECG to identify heart...
...of methadone into 6–8 hour doses is re...
...Some OTPs may be able to offer a...
If prescribing additional methadone is...
...cerbations in pain or “breakthrough painâ...
...renorphine...
...inicians should utilize adjuvant therapy a...
...expert opinion, the clinician should in...
...t opinion, clinician’s might switc...
...recommends, if a maximal dose of b...
...al doses of an additional opioid are ineffect...
...n buprenorphine maintenance with inadequate...
...al Health Disorder...
...ns should fully review a patientâ€...
...ients should be screened for depression wit...
...-9a, a questionnaire in the public domain, is r...
...should be screened for co-morbid n...
...is recommended that all patients with chron...
...ww.integration.samhsa.gov/images/res/PHQ%20-...