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New HIVMA guidelines recommend screening everyone with HIV for chronic pain

From News Medical - September 14, 2017

Because ongoing pain is a significant problem that affects 39 to 85 percent of people living with HIV, everyone with the infection should be assessed for chronic pain, recommend guidelines released by the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) and published in the journal Clinical Infectious Diseases. Those who screen positive should be offered a variety of options for managing pain, starting with non-drug treatment such as cognitive behavioral therapy, yoga and physical therapy, suggest the first comprehensive guidelines on HIV and chronic pain.

"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," said Douglas Bruce, MD, MA, MS, lead author of the guidelines, chief of medicine at Cornell Scott-Hill Health Center, and associate clinical professor of medicine at Yale University, New Haven, Conn. "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."

The guidelines recommend all people with HIV be screened for chronic pain using a few simple questions:

Those that screen positive should undergo comprehensive evaluation, including a physical exam, psychosocial evaluation and diagnostic testing. Nearly half of chronic pain in people with HIV is neuropathic (nerve pain), likely due to inflammation or injury to the central or peripheral nervous system caused by the infection. Non-neuropathic pain typically is musculoskeletal, such as low-back pain and osteoarthritis in the joints.

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