HIV

IDSA/HIVMA: Screen All HIV-Infected Individuals For Chronic Pain

The Infectious Diseases Society of American and the HIV Medicine Association recently released comprehensive guidelines for the management of chronic pain in persons living with HIV.

“It has been long known that patients with HIV/AIDS are at high risk for pain, and for having their pain inadequately diagnosed and treated,” stated lead author Dr Douglas Bruce, chief of medicine at Cornell Scott-Hill Health Center.2 
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Due to the high prevalence of chronic pain among persons with HIV, which ranged from 39% to 85% depending on the study, the authors recommended that physicians screen all patients living with HIV.1 They suggested asking patients, at minimum, the 2 following questions:

  •  “How much bodily pain have you had during the last week?”
  • “Do you have bodily pain that has lasted for more than 3 months?”

The panel also recommended:

  • Medical providers should assess all patients who screen positive for chronic pain using a biopsychosocial approach followed by physical examination, psychosocial evaluation, and diagnostic work up.
  • Cognitive behavioral therapy, yoga, physical and occupational therapy, and hypnosis are recommended as non-pharmacological interventions for the management and treatment of chronic pain.
  • Gabapentin is recommended as first-line treatment for chronic HIV-associated neuropathic pain.
  • Acetaminophen and nonsteroidal anti-inflammatory drugs are recommended as first-line therapies for musculoskeletal pain.
  • Capsaicin, as a topical treatment, lamotrigine, and alpha lipoic acid, are recommended for peripheral neuropathic pain.
  • Opioids are not recommended as first-line therapy for treating chronic pain, but could be prescribed to patients who are not responding to first-line treatment.

In addition, the guidelines offer recommendations for how to evaluate patients with chronic pain, approaches for treating patients who will initiate opioids to prevent opioid use disorder, and common tools used to screen persons living with HIV for mental health disorders.

“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. These guidelines help provide clarity in treating these patients,” stated Dr Bruce.

—Melissa Weiss

Reference:

1) 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. https://doi.org/10.1093/cid/cix636.

2) Chronic pain common in people living with HIV [press release]. Arlington, VA: Infectious Diseases Society of American, September 14, 2017. http://www.idsociety.org/News_and_Publications/IDSA_News_Releases/2017/Pages/Chronic_Pain_Common_in_People_Living_with_HIV.aspx. Accessed September 14, 2017.