A vast range of pain syndromes are common in patients who have HIV/AIDS. Some are the result of HIV infection, others result from immunosuppression, and others are unrelated but comorbid with AIDS. Pain commonly results from painful neuropathy, Kaposi’s sarcoma, herpes zoster, candida esophagitis, drug-induced pancreatitis, headache (including those resulting from meningitis), and numerous types of joint and myofascial pains.
Patients are often both indigent and negatively viewed by clinicians—conditions that lead to reduced access to pain care. The patients may be sick, frail, and cachectic, creating challenges in the use of pharmacotherapies. A large number of patients have a comorbid SUD, which complicates the use of opioid analgesics.
Core principles of treating CNCP, such as meticulous diagnosis of the pain mechanism and etiology and monitoring for benefits and adverse effects of treatment, and use of the World Health Organization’s pain ladder (see http://www.who.int/cancer/palliative/painladder/en/index.html) for titrating analgesics are applicable in this population. However, addressing the psychological aspects of the illness, as well as functional restoration, is especially important. Nonpharmacological therapies, including PT modalities, acupuncture, biofeedback training, and hypnosis, may be helpful.
From: 3, Chronic Pain Management
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