➤ Chronic pain remains a significant problem in persons living with HIV
(PLWH) and is associated with psychological and functional morbidity,
even in the absence of advanced disease complications. Depending upon
the study, current prevalence estimates of chronic pain in PLWH ranges
from 39%–85%.
➤ Nearly half of that pain is neuropathic, due to injury to the central or
peripheral nervous systems from direct viral infection, infection with
secondary pathogens, or side effects of medications.
➤ Non-neuropathic pain, such as nociceptive pain, in PLWH is caused by
tissue injury as a result of inflammation (e.g., autoimmune responses),
infection (e.g., bacteria, other viruses, tuberculosis), or neoplasia (e.g.,
lymphoma or sarcoma).
Key Points
Screening And Initial Assessment
➤ All persons living with HIV should receive, at minimum, the following
standardized screening for chronic pain: (S-L)
• "How much bodily pain have you had during the last week? (None, very mild, mild,
moderate, severe, very severe)"
• "Do you have bodily pain that has lasted for more than 3 months?"
Remark: A response of moderate pain or more during the last week combined with bodily pain
for >3 months can be considered a positive screen result.
➤ For persons who screen positive for chronic pain, an initial assessment should
take a biopsychosocial approach that includes an evaluation of the pain's
onset and duration, intensity and character, exacerbating and alleviating
factors, past and current treatments, underlying or co-occurring disorders
and conditions, and the effect of pain on physical and psychological function;
followed by a physical examination, psychosocial evaluation, and diagnostic
workup to determine the potential cause of the pain (S-VL).
Remark: A multidimensional instrument such as the Brief Pain Inventory
a
or the 3-Item
PEG
b
can be used for pain assessments.
➤ Medical providers should monitor the treatment of chronic pain in PLWH
with periodic assessment of progress on achieving functional goals and
documentation of pain intensity, quality of life, adverse events, and
adherent versus aberrant behaviors (S-VL).
Remark: Reassessments should be conducted at regular intervals and after each change or
initiation in therapy has had an adequate amount of time to take effect.
Diagnosis
a
https://www.painedu.org/Downloads/NIPC/Brief_Pain_Inventory.pdf
b
http://health.gov/hcq/trainings/pathways/assets/pdfs/PEG_scale.pdf
