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
Diagno...
...and Initial Assessment...
...sons living with HIV should receive, at minimum,...
...who screen positive for chronic pain,...
...oviders should monitor the treatment of chronic...
Treatment
Treatment
...nagemen...
...medical providers should develop and particip...
...r patients whose chronic pain is co...
...ons living with HIV age, their pain exper...
...itical to maintaining pain control, it i...
...onsultation with a palliative care special...
...ts with advanced illness require a supp...
...n-Pharmacological Tre...
...ognitive behavioral therapy (CBT) is recom...
...is recommended for the treatment of chronic n...
...hysical and occupational therapy is recommended f...
...s recommended for neuropathic pain. ( S ,...
...consider a trial of acupuncture for chro...
...armacological Treatments For Neuropathic Pain
...-Opioids...
...y initiation of anti-retroviral therapy (ART)...
...commended as a first line oral phar...
...l adult regimen will titrate to 2,400 mg pe...
...ients have an inadequate response to g...
b. If patients have an inadequate response to gab...
...ents have an inadequate response to gabape...
...cin is recommended as a topical treatment for the...
...emark: A single 30-minute application of an...
...cal cannabis may be an effective treatm...
...ends alpha lipoic acid (ALA) for the managemen...
...recommends against using lamotrigine t...
...ioids...
...living with HIV, opioid analgesics should...
...inicians may consider a time-limited trial o...
...cological Treatments For Non-Neuropathic...
...Opioids...
...ophen and NSAIDS are recommended as fi...
...pioids
...ents who do not respond to first line...
...taken up to three months may decrease pai...
...equences of Opioid Treatment (e.g.,...
...hould assess all patients for the possible...
...tine monitoring of patients prescribed op...
...n “opioid patient-prescriber agreement”...
...hould understand the clinical uses and...
...tances should be stored safely away from...
...inicians should teach patients and...
Patient education is recommended t...
...be knowledgeable about common pharmacologica...
...ibers should follow patients close...
...ns with a history of a substance use disor...
Persons with a history of addiction...
...ethadone...
...ease of information to exchange he...
...ing with ECG to identify heart rate c...
...splitting of methadone into 6–8 hou...
...k: Some OTPs may be able to offer a split...
...ribing additional methadone is not possible,...
...erbations in pain or “breakthrough pain” s...
...uprenorphine
...ans should utilize adjuvant therapy a...
Based on expert opinion, the clinician should...
...ed on expert opinion, clinician’...
...recommends, if a maximal dose of buprenorphine...
...of an additional opioid are ineffec...
...r patients on buprenorphine maintenance w...
Mental Health Disord...
...nicians should fully review a patient’s baselin...
...ents should be screened for depression wi...
...uestionnaire in the public domain, is recomme...
...should be screened for co-morbid ne...
...is recommended that all patients with chro...
...ntegration.samhsa.gov/images/res/PHQ%20-%...