Chronic Pain and HIV A Practical Approach

Patients suffering from HIV/AIDS often experience chronic pain due to the many diseases and infections they pick up as a result of a weakened immune system. It interferes with their quality of life and physical functioning, impacts adherence to antiretroviral therapy and HIV primary care, and is associated with significant psychological/social distress and substance use disorders.

Chronic Pain and HIV addresses all these complex issues that can influence pain care that can influence pain care for the patient with HIV and acts both as a primer and a comprehensive review to define the field of chronic pain management. Using a clear, clinical approach, key topics include the following:

• Musculoskeletal pain in individuals in HIV
• Headache in individuals with HIV
• Psychiatric comorbidities among individuals with HIV and chronic pain
• Potential benefit and harm of prescription opioids in HIV
• Pain at the end of life in individuals with AIDS
• Treatment of chronic pain syndromes in the HIV-infected person.

Edited by an outstanding team with extensive experience in HIV/AIDS and pain/palliative care, every chapter is written by a world-famous expert in their field who provides a thorough review of the relevant literature, including the very latest in management guidelines from the leading international societies.

Perfect for all those in primary care, as well as infectious disease specialists managing patients with HIV/AIDS, Chronic Pain and HIV provides sensible, straightforward clinical advice to ensure the best possible patient management.

Jessica S. Merlin, MD, MBA, Assistant Professor, Department of Medicine, Division of Infectious Diseases, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham.

Peter Selwyn, MD, MPH, Professor, Department of Family and Social Medicine, Albert Einstein College of Medicine.

Glenn Treisman, MD, PhD, Professor, Department of Psychiatry and Behavioral Sciences, Professor, Department of Internal Medicine, Johns Hopkins University School of Medicine.

Angela G. Giovanniello, PharmD, AAHIVP, Department of Family and Social Medicine, Albert Einstein College of Medicine.

Foreword vii

About the editors ix

List of contributors xi

1 Epidemiology of chronic pain in HIV-infected individuals 1

2 Pathophysiology of chronic pain in individuals with HIV 7

3 Chronic pain assessment, diagnostic testing, and management, with an emphasis on communication about these topics to individuals with HIV 16

4 HIV and chronic pain: musculoskeletal pain 27

5 Headache in HIV 38

6 HIV and peripheral neuropathy 51

7 Common medical comorbid conditions and chronic pain in HIV 63

8 Psychiatric comorbidities among individuals with HIV and chronic pain 71

9 Comorbid substance use among persons with HIV and chronic pain 78

10 Pharmacologic and Non-Pharmacologic treatment approaches to chronic pain in individuals with HIV 97

11 Potential benefits and harms of prescription opioids in HIV 113

12 Safer opioid prescribing in HIV-infected patients with chronic pain 123

13 The “difficult patient” with HIV and chronic pain, 137

14 HIV-related pain in low- and middle-income countries with reference to sub-Saharan Africa 150

15 Pain at the end of life in individuals with AIDS 157

16 Disparities and barriers in management of chronic pain among vulnerable populations with HIV infection 165

Index 177

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