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Chronic Pain in HIV

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➤ 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 b

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