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

...gnosis...

...ening and Initial Assessment...

...ons living with HIV should receive, at minimu...

...s who screen positive for chronic pa...

...l providers should monitor the treatmen...


Treatment

...reatment...

Managem...

HIV medical providers should develop and partic...

...r patients whose chronic pain is c...

...living with HIV age, their pain exp...

...intaining pain control, it is recommended that me...

...tion with a palliative care specialis...

...with advanced illness require a su...


...rmacological Treatments...

...havioral therapy (CBT) is recommended for c...

...recommended for the treatment of chronic neck/b...

...ccupational therapy is recommended fo...

...ypnosis is recommended for neuropathic pai...

...cians might consider a trial of acupuncture for c...


...gical Treatments For Neuropathic P...

...n-Opioid...

...arly initiation of anti-retroviral ther...

...s recommended as a first line oral pharmacologica...

...al adult regimen will titrate to 2,400 mg per day...

...s have an inadequate response to gabapentin, clin...

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

...ave an inadequate response to gabapenti...

...apsaicin is recommended as a topical t...

...rk: A single 30-minute application...

...annabis may be an effective treatment in appropr...

...mmends alpha lipoic acid (ALA) for the managemen...

...mmends against using lamotrigine to relie...

Opioi...

...iving with HIV, opioid analgesics shou...

Clinicians may consider a time-limi...


...cal Treatments For Non-Neuropathic Pain...

Non-Opioids...

...etaminophen and NSAIDS are recommended as fi...

...pioids

...not respond to first line therapies and...

...up to three months may decrease pain, impro...

...nces of Opioid Treatment (e.g., misuse, substance...

...ribers should assess all patients for the po...

...ine monitoring of patients prescribed opioid ana...

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

...should understand the clinical uses and limit...

...rolled substances should be stored sa...

...icians should teach patients and their caregiver...

...education is recommended to help patients avoid ad...

...should be knowledgeable about common pharmacologic...

...should follow patients closely whe...

...with a history of a substance use disorde...

Persons with a history of addiction...

Methadon...

...of information to exchange health information...

...reening with ECG to identify heart rat...

...f methadone into 6–8 hour doses i...

Remark: Some OTPs may be able to offer a s...

...additional methadone is not possible, (e.g....

...exacerbations in pain or “breakthrou...

...enorphine

...uld utilize adjuvant therapy appropriat...

...t opinion, the clinician should increase the d...

...opinion, clinician’s might switch from buprenor...

...mmends, if a maximal dose of buprenorphine i...

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

...tients on buprenorphine maintenance with inadequat...


...l Health Disorders...

...ans should fully review a patient’s baselin...

...ll patients should be screened for depression w...

...a questionnaire in the public domain, is recomm...

...s should be screened for co-morbid neurocogni...

...mmended that all patients with chronic pa...

...http://www.integration.samhsa.gov...