Pain in People Living with HIV
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, it has been estimated taht up to one-third of 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:
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]. Depression has specifically been associated with greater intensity in neuropathic pain in PLWH[2]
- 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]
- Prevalence:Up to one-third of PLWH suffer from HIV-sensory-neuropathy, with some studies reporting incidence rates of up to 50%[2]. Of those with neuropathy, 38-75% experience painful neuropathy (neuropathic pain)[2]
- Cause: HIV-related neuropathy can be caused by the direct effect of the virus, or as a side-effect of ART.
- Signs and Symptoms: Regardless of the cause, symptoms and clinical signs are similar and include distal polyneuropathy and ----------[2]
Joint Pain[edit | edit source]
Upper and Lower Extremity Pain[edit | edit source]
Pathophysiology of Pain in HIV[edit | edit source]
Nucleoside analogue-transcriptase inhibitors (NRTIs) (examples) have be closely linked with neuropathy.
Interventions for Pain in PLWH[edit | edit source]
Pharmacologic[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" [3]
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)[4].
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)[4][2]. 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[4].
- Capsaicin: There is some evidence of a short term positive effect on pain in PLWH[2]
Non-Pharmacologic[edit | edit source]
Non-pharmacological interventions seem the hold the most promise in addressing HIV related pain. There is however still a great need for further, high-quality research to determine which interventions are superior and the most cost-effective and feasible in different contexts[2].
Exercise[edit | edit source]
Maharaj - effective
Mkadla - not effective
Psychological Interventions[edit | edit source]
- Relaxation: Yoga, relaxation strategies and mindfulness may provide benefits, especially when anxiety and depression in present
- Cognitive Behavioural Therapy (CBT): A recent systematic review found that CBT can result in significant reductions in neuropathic pain intensity[2]
- Supportive Psychotherapy: Effectiveness is comparable with CBT, for neuropathic pain[2]
Education and Self-management[edit | edit source]
Therapeutic Relationship[edit | edit source]
Other[edit | edit source]
- Massage: There is low to moderate evidence to support the use of massage in PLWH. It may improve quality of life, but it has not been shown to have any effect on pain on activity levels. Given the lack of evidence, it could be useful as a self-management/care-giver tool, but should not be the focus of pain management programmes/interventions[5].
- Splinting: Night splinting for neuropathic pain has not been found to be effective[2]
Chronic Pain[edit | edit source]
Resources[edit | edit source]
- Positive Living Workbook - Developed by Romy Parker, Available in English, Afrikaans and isiXhosa[6]
References[edit | edit source]
- ↑ 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.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Amaniti A, Sardeli C, Fyntanidou V, Papakonstantinou P, Dalakakis I, Mylonas A, Sapalidis K, Kosmidis C, Katsaounis A, Giannakidis D, Koulouris C. Pharmacologic and non-pharmacologic interventions for HIV-neuropathy pain. A systematic review and a meta-analysis. Medicina. 2019 Nov 28;55(12):762.
- ↑ 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.
- ↑ 4.0 4.1 4.2 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.
- ↑ Hillier SL, Louw Q, Morris L, Uwimana J, Statham S. Massage therapy for people with HIV/AIDS. Cochrane database of systematic reviews. 2010(1).
- ↑ Parker, R. 2014. Positive Living Workbook. Lesson plan. University of Cape Town.
