All HIV-Positive People Should Be Screened For Chronic Pain

For many people living with HIV, chronic pain is often an unspoken symptom. In fact, according to a study released by the HIV Medicine Association of the Infections Diseases Society of America published in Clinical Infections Diseases, 39 to 85 percent of HIV-positive say that ongoing pain is a problem impacting their daily lives. 

Researchers recommend that due to the high number of poz people dealing with chronic pain, health officials ought to screen their patients living with HIV for chronic pain by asking them two important questions: 

* How much bodily pain have you had during the week?
* Do you have bodily pain that has lasted more than three months?

Leaders of the study recommend non-drug options to offset pain, such as yoga and physical therapy, and cognitive behavioral therapy to promote mental and emotional health, which would also help with depression — another common symptom among poz people. 

It was discovered over the course of the study that nearly half of the chronic pain HIV-positive people experience is neuropathic, i.e. nerve pain, due to inflammation or injury to the central or peripheral nervous system cause by the virus. Those who don’t suffer from neuropathic pain often deal with musculoskeletal pain, in the lower back or in the joints (like osteoarthritis).  

Dr. Peter Selwyn, chair of the Department of Family and Social Medicine, recommends those who screen positive for chronic pain should complete an evaluation — a physical exam, psychosocial evaluation, and diagnostic testing — to determine further treatment. 

“This is an aging population and the changing clinical manifestations of HIV, complexity of the disease and additional challenges related to substance abuse make treatment complicated,” Selwyn said. “These guidelines help provide clarity in treating these patients.”

While these guidelines push for a non-drug form of treatment, for people with conditions that require drugs, Selwyn recommends non-opioids to help with nerve pain, like gabapentin (an anti-seizure medication) and capsaicin (a pain reliever constructed from chili peppers). 

“Opioids are never first-line,” said Dr. Douglas Bruce, lead author of the guidelines, said. “The guidelines always recommend the most effective treatment with the lowest risk.” 

Bruce continued: “Because HIV clinicians typically are not experts in pain management, they should work closely with others, such as pain specialists, psychiatrists, and physical therapists to help alleviate their patients’ pain… These comprehensive guidelines 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 such as diabetes.”