Chronic pain management in HIV: Updated recommendations
Nonpharmacologic pain management in patients with HIV include cognitive behavioral therapy, yoga, and physical therapy.
The HIV Medicine Association of the Infectious Diseases Society of America recommends that people living with HIV be screened for pain and offered both nonpharmacologic and pharmacologic treatment options, according to new guidelines published in Clinical Infectious Diseases.1
The guideline panel was comprised of 10 experts in HIV, pain, pharmacology, psychiatry, palliative care, and addiction medicine, who reviewed the literature to formulate recommendations for the treatment of denervation pain, neuropathic pain, and musculoskeletal pain in people living with HIV.
The guidelines recommended that patients who screen positive for chronic pain should be evaluated with a physical examination, psychosocial evaluation, and diagnostic testing to determine the underlying cause of the pain.
The first line of treatment is nonpharmacologic management, which includes cognitive behavioral therapy, yoga, and physical therapy. If nonpharmacologic treatment is not sufficient for pain management, clinicians may consider non-opioid drugs, such as gabapentin, topical capsaicin, or medical cannabis.
For patients with neuropathic pain and inadequate response to gabapentin, antidepressants and pregabalin may be considered. Nonsteroidal anti-inflammatory drugs are recommended for patients with musculoskeletal pain.
According to the recommendations, chronic pain should be managed by an interdisciplinary team of specialists in HIV and pain as well as the patient's primary care provider. Multidisciplinary care is particularly important for patients with co-occurring substance use or psychiatric disorders.
The guidelines also emphasize the importance of inpidualized decision making. The study authors noted that, “although chronic pain is common in [people living with HIV], many questions remain unanswered. Findings from studies conducted in the general population are not always generalizable to [this patient population].”
- Bruce RD, Merlin J, Lum PJ, et al. 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV [published online September 14, 2017]. Clin Infect Dis. doi: 10.1093/cid/cix636