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Chronic Pain in HIV

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Mental Health Disorders ➤ Clinicians should fully review a patient's baseline mental health status for modifiable factors that can impact successful pain management (S-L). Remark: Potentially modifiable factors include: self-esteem and coping skills, recent major loss or grief, unhealthy substance use, history of violence or lack of safety in the home, mood disorders, history of serious mental illness or suicidal ideation. ➤ All patients should be screened for depression with the following two questions (S-H): 1. During the past two weeks have you often been bothered by feeling down, depressed, or hopeless? 2. During the past two weeks have you been bothered by little interest or pleasure in doing things? Remark: If the patient answers in the affirmative to either question, a follow-up question regarding help should be asked: "Is this something with which you would like help?" ➤ The PHQ-9 a , a questionnaire in the public domain, is recommended as a screening tool in clinical settings without access to trained mental health professionals since it can be used to diagnose depression (S-H). Remark: Psychiatric follow-up for result ≥10 (88% sensitivity and 88% specificity for major depression) is recommended, and the clinical site should have a policy for referrals for more in-depth evaluation of these issues. ➤ All patients should be screened for co-morbid neurocognitive disorders prior to and during use of long-term opioid therapy (S-L). Remark: Questions administered to elicit cognitive complaints in the Swiss HIV Cohort study (e.g., frequent memory loss; feeling slower when reasoning, planning activities, or solving problems; and difficulties paying attention) detected, but have not been tested as screening questions in the clinical setting. ➤ It is recommended that all patients with chronic pain have a full neuropsychiatric evaluation with history, physical and use of the HIV Dementia Scale b , or an equivalent to document baseline capacity (S-H). Source Bruce RD et al. 2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Infected with HIV a http://www.integration.samhsa.gov/images/res/PHQ%20-%20Questions.pdf b http://ccoe.rbhs.rutgers.edu/online/ARCHIVE/12HC03/article4.htm Disclaimer is Guideline attempts to define principles of practice that should produce high-quality patient care. It is applicable to specialists, primary care, and providers at all levels. is Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. e ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aer consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool.

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