New guidelines released by the HIV Medicine Association (HIVMA) and published in Clinical Infectious Diseases recommend that everyone living with HIV be assessed for chronic pain, a significant problem that affects 39 to 85 percent of people living with HIV. These comprehensive guidelines, the first for HIV and chronic pain, provide the tools and resources HIV specialists need to treat these often-complex patients, many of whom struggle with depression, substance use disorders, and have other health conditions.
Those who screen positive should undergo comprehensive evaluation, including a physical exam, psychosocial evaluation, and diagnostic testing. Nearly half of chronic pain experienced by people with HIV is neuropathic, likely due to inflammation or injury to the central or peripheral nervous system caused directly or indirectly by HIV infection. Non-neuropathic pain typically is musculoskeletal, such as low-back pain and osteoarthritis in the joints. These latter problems will be seen more frequently as HIV patients age.
HIV specialists should work with an interdisciplinary team to offer multi-modal treatment. The guidelines recommend offering alternative, non-pharmacological therapies first, including cognitive behavioral therapy, yoga, physical and occupational therapy, hypnosis, and acupuncture. If medication is needed, the guidelines recommend beginning with non-opioids, such as gabapentin and capsaicin, both of which help with neuropathic pain.
The online version of the guidelines includes a list of resources for physicians to reference to help them treat the patients comprehensively.
The guidelines panel included experts who specialize in HIV, substance abuse, pain, psychiatry, palliative care, and pharmacology. In addition to lead authors, Douglas Bruce, MD, MA, MS, and Peter Selwyn, MD, MPH, the guidelines panel included: Ebtesam Ahmed, PharmD; Carla Alexander, MD; Amanda H. Corbett, PharmD; Kathleen Foley, MD; Kate Leonard, MD; Paula J. Lum, MD, MPH; Jessica Merlin, MD, MBA; and Glenn Jordan Treisman, MD, PhD.
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