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.
