HIV Medicine Association Releases Guidelines for Chronic Pain Management

Those living with human immunodeficiency virus (HIV) often experience chronic pain. The HIV Medicine Association (HIVMA) of the Infectious Disease Society of America (IDSA) recently published clinical practice guidelines for managing this chronic pain.

The guidelines, published in Clinical Infectious Diseases, include recommendations for those with HIV who experience chronic pain. The report defined the different types of pain that a patient could experience—including denervation pain, neuropathic pain, and musculoskeletal pain—while providing insight from a panel of 10 experts in HIV, pain, pharmacology, psychiatry, palliative care, and addiction medicine to develop recommendations for clinical practitioners.

“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,” 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, said in a statement from IDSA. “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 instructed patients that screen positive for chronic pain with HIV should participate in a physical exam, psychosocial evaluation, and diagnostic testing. The authors also recommend that HIV specialists work with an interdisciplinary team to offer alternative therapies, such as cognitive behavioral therapy, yoga, physical and occupational therapy, hypnosis, and acupuncture. Also, if the physician thinks medicine is necessary, the guidelines suggest prescribing non-opioid medications.

“It has been long known that patients with HIV/AIDS are at high risk for pain, and for having their pain inadequately diagnosed and treated,” stated Peter Selwyn, MD, MPH, co-chair of the guidelines and professor and chair of the Department of Family and Social Medicine, and director of the Palliative Care Program for Montefiore Medical Center, Albert Einstein College of Medicine, in the news release.

The guidelines are intended to act as a reference and resource for physicians when treating patients; however, the study noted that the guidelines cannot account for individual patient variations.

“This is an aging population and the changing clinical manifestations of HIV, complexity of the disease and additional challenges related to substance abuse make treatment complicated. These guidelines help provide clarity in treating these patients,” Selwyn concluded.