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Chronic Pain in Patients With HIV: What Clinicians Need to Know

Understanding chronic pain in HIV patients is crucial, as it can significantly impact their quality of life. This resource covers prevalence, coexisting conditions, treatment strategies, and communication tips for healthcare providers.

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Chronic Pain in Patients With HIV: What Clinicians Need to Know

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  1. Chronic Pain in Patients With HIV: What Clinicians Need to Know Jessica S. Merlin, MD, MBAAssistant Professor of MedicineUniversity of Alabama at Birmingham Birmingham, Alabama FORMATTED: 11/03/2015 New Orleans, Louisiana: December 15-17, 2015

  2. HIV and Chronic Pain in the Current Treatment Era • Prevalence as high as 39-85% • Often coexists with mood disorders and addiction • Often musculoskeletal • Associated with key outcomes (functional impairment, retention) • Can be challenging for HIV providers Merlin JS, JAIDS, 2012; Merlin JS, J Pain Symptom Manage, 2011; Cervia LD, Pain Med, 2010; Lee KA, J Pain Symptom Manage, 2008; Tsao JC, Pain 2011, Lum P, JAIDS 2011.

  3. Communicating About Chronic Pain • Not easy, because: • Patients come with “baggage” • Providers come with “baggage” • Pain is the 5th vital sign, pain is an emergency • Medications come with risk • Patients may have active psychiatric illness/addiction • Patients’ behaviors may evoke severe negative countertransference

  4. Initial Discussion What is chronic pain Patience Partnership and collaboration Pharmacologic and non-pharmacologic management Mind-body connection Functional goals Motivational interviewing can be very useful

  5. Evidence-Based Non-OpioidPharmacologic Therapy • Acetaminophen - OA, < 3g, consider relative contraindications • NSAIDs - back pain, consider CV (naproxen), GI (cox-2/celecoxib), renal risk • Muscle relaxants • Benzodiazepines • Other: anticonvulsants, antidepressants, topicals • Specific indications: e.g., lidocaine post-herpetic neuralgia, capsaicin post-herpetic/DSP, diclofenac-OA

  6. My take on opioids • They ARE NOT first-line therapy for chronic pain • They work for some people • However, evidence of benefit is limited • What we know about their risk is growing

  7. Evidence-Based Non-Pharmacologic Strategies Hayden JA, Cochrane Database Syst Rev, 2005; Trafton JA, J Behav Health Serv Res, 2012; Cucciare CA, J Behav Med, 2009; Vickers AJ, Arch Int Med, 2012. ICSI Guideline for Management of Chronic Pain; Turk DC, Lancet, 2011, Mirza SK, Spine, 2007. Behavioral approaches Physical therapy Exercise Interventional treatments Complementary and alternative therapies Surgery

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