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

Diagnos...

...g and Initial Assessment...

...l persons living with HIV should receive, at mi...

...s who screen positive for chronic pain, an initi...

...ders should monitor the treatment of chr...


Treatment

...eatment...

...nagemen...

...V medical providers should develop and partic...

...or patients whose chronic pain is controll...

As persons living with HIV age, their pain ex...

...cal to maintaining pain control, it is...

...sultation with a palliative care spe...

...ents with advanced illness require a s...


...acological Treatments...

...behavioral therapy (CBT) is recommended for chron...

...nded for the treatment of chronic...

...nd occupational therapy is recommended for c...

...nosis is recommended for neuropath...

...cians might consider a trial of acup...


...rmacological Treatments For Neuropa...

Non-Opioid...

...tion of anti-retroviral therapy (AR...

...is recommended as a first line oral pharmac...

...: A typical adult regimen will titr...

a. If patients have an inadequate respo...

.... If patients have an inadequate re...

...s have an inadequate response to gabapent...

...ecommended as a topical treatment for the mana...

Remark: A single 30-minute application...

...ical cannabis may be an effective treatment...

...mends alpha lipoic acid (ALA) for the man...

...mmends against using lamotrigine to re...

...pioid...

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

...linicians may consider a time-limited tri...


...l Treatments For Non-Neuropathic Pain...

...n-Opioids

...and NSAIDS are recommended as first-line age...

Opioid...

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

...n up to three months may decrease pai...

...nsequences of Opioid Treatment (e.g., misuse,...

...ers should assess all patients for...

...outine monitoring of patients prescribed...

...opioid patient-prescriber agreement” is r...

...should understand the clinical uses and li...

...bstances should be stored safely away from indi...

...ans should teach patients and their caregivers...

...education is recommended to help patien...

...ould be knowledgeable about common pharmacologic...

...ould follow patients closely when intera...

...th a history of a substance use disorder addiction...

...ns with a history of addiction for whom the...

...hadone...

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

...l screening with ECG to identify heart rate corre...

...ting of methadone into 6–8 hour...

...Ps may be able to offer a split-dose methado...

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

...cute exacerbations in pain or “breakthroug...

...prenorphin...

...d utilize adjuvant therapy appropri...

...expert opinion, the clinician should in...

...on expert opinion, clinician’s might switch...

...DSA recommends, if a maximal dose of bupreno...

...usual doses of an additional opioid...

...ts on buprenorphine maintenance wi...


...ntal Health Disorders...

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

...uld be screened for depression with the following...

...PHQ-9a, a questionnaire in the public domain...

...should be screened for co-morbid neuroco...

...s recommended that all patients with chr...

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