Pain in People Living with HIV

Original Editor - Melissa Coetsee Top Contributors - Melissa Coetsee and Carina Therese Magtibay
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Introduction[edit | edit source]

Since the introduction of Anti-retroviral Therapy (ART), there has been a significant reduction in the mortality associated with Human Immunodeficiency Virus (HIV). As a result more people are living with HIV as a chronic condition, and this has necessitated an increased focus on factors affecting quality of life. Pain is one such a factor that has been shown to negatively affect quality of life and function in people living with HIV (PLWH)[1].

The prevalence of pain among PLWH vary among populations. Parker et al. (2014)[1] found that pain (mostly moderate to severe) is reported in 54-67% of PLWH. In later studies, prevalence rates remained high, indicating that pain remains poorly addressed.

It is clear that pain is a prominent concern in PLWH, and it remains poorly controlled and undertreated in this population[1].

Impact of Pain[edit | edit source]

Untreated and poorly managed pain can be very debilitating. In PLWH it has been shown to have significant negative effects on the following:

  1. Sleep[1]
  2. Ability to work[1]
  3. Mood[1]


This clearly demonstrates the importance of addressing pain in PLWH in order to limit its impact on quality of life and function[1]

Factors Contributing to Pain[edit | edit source]

The following factors have been found to increase the risk of pain in PLWH:

  • Depression and anxiety[1]
  • Lack of social support[1]
  • Lower level of education, in both developing and developed contexts[1]

Common Pain Conditions[edit | edit source]

Spinal Pain[edit | edit source]

Neuropathy[edit | edit source]

Joint Pain[edit | edit source]

Upper and Lower Extremity Pain[edit | edit source]

Pathophysiology of Pain in HIV[edit | edit source]

Interventions for Pain in PLWH[edit | edit source]

Pharmaceutical[edit | edit source]

Various studies have failed to identify drugs that have proven effectiveness in reducing pain (especially neuropathic pain) in PLWH. The South African Medical Research Council has reported that there is an "absence of empirical evidence supporting efficacy of pharmacological agents typically recommended for the management of neuropathic pain in this population group" [2]

ART[edit | edit source]

There is no correlation between ART and pain reduction, which indicates that treatment of the virus alone is not effective in managing pain in PLWH[1]

Neuropathic Pain Medication[edit | edit source]

Medications often used to treat neuropathic pain have not been effective in relieving HIV related neuropathic pain - these include anti-depressants, anticonvulsants, topical agents, opioids and non-steroidal anti-inflammatories (NSAIDs)[3].

Other[edit | edit source]
  • Cannabis: There is some evidence that smoking cannabis has been shown to have a positive effect on neuropathic pain in PLWH, by activating the endocannabinoid system (ECS)[3]. It is however not recommended as a feasible option for pain management, as HIV is a chronic condition and the long-term use of smoked cannabis can have negative psycho-active effects. The research does however suggest that targeting cannabinoid receptors may be an effective approach in managing neuropathic pain in PLWH. Non-psychoactive cannabinoids administered via other routes would be more suitable and requires further research[3].

Non-Pharmaceutical[edit | edit source]

Exercise[edit | edit source]
Psychological Interventions[edit | edit source]
  1. Relaxation: Yoga, relaxation strategies and mindfulness may provide benefits, especially when anxiety and depression in present
  2. Cognitive Behavioural Therapy (CBT):
Education and Self-management[edit | edit source]
Therapeutic Relationship[edit | edit source]

Chronic Pain[edit | edit source]

Resources[edit | edit source]

References[edit | edit source]

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Parker R, Stein DJ, Jelsma J. Pain in people living with HIV/AIDS: a systematic review. Journal of the International AIDS Society. 2014 Jan;17(1):18719.
  2. Augustine TN, Cairns CJ, Chetty S, Dannatt LG, Gravett N, Grey G, Grobler G, Jafta Z, Kamerman P, Lopes J, Matsabisa MG. Priority areas for cannabis and cannabinoid product research in South Africa. African Journal of Primary Health Care & Family Medicine. 2018;10(1):1-3.
  3. 3.0 3.1 3.2 Aly E, Masocha W. Targeting the endocannabinoid system for management of HIV-associated neuropathic pain: a systematic review. IBRO Neuroscience Reports. 2021 Jun 1;10:109-18.
  4. Parker, R. 2014. Positive Living Workbook. Lesson plan. University of Cape Town.