HIV-related pain

People with HIV can experience severe bouts of pain. Pain can be due to the HIV infection, opportunistic infections, gut problems, cancers, nerve damage and or treatment side effects.

There are various types of pain—headaches, neuropathic pain, gastrointestinal pain and chest pain. Headaches can vary in intensity and can result from stress, nervous system infection or migraines.

Neuropathic pain is a burning or numbing sensation in the hands, feet and face. Gastrointestinal pain can affect the throat through to the stomach and intestines. Infections like pneumonia and TB can cause chest pain.

A person with HIV can experience two to three different types of pain in different parts of the body over a short term (acute) or long term (chronic). Pain significantly impacts on quality of life with persons not only suffering from agonising distress but also finding daily tasks, work, social activities difficult to do.

Pain is in often left undiagnosed and untreated for a number of reasons including poor access to treatment and the focus by clinicians on identifying and treating a specific infection that results in less of a concern for treating pain is.

When a person with HIV is in pain they should seek treatment for the pain. Doctors should undertake a pain assessment where a patient self-reports i.e. patient says how severe the pain.

The pain assessment will ask questions related to the onset, duration, location, character (sharp, dull, burning, etc…), intensity – using the 0-10 numerical rating scale, the verbal scale (none, mild, moderate, severe) of the pain.

If the pain is due to an opportunistic infection or drug then switching medications or treating the infection can help alleviate the pain. Sometimes the pain can be treated directly.

The World Health Organisation has a pain relief ladder which recommends different treatments based on the severity of pain. For mild pain, drugs such as aspirin, ibuprofen or aspirin are recommended. If pain remains and is increasing, drugs such as codeine are recommended. If the pain is still increasing and persisting then drugs such as morphine or methadone are recommended.

Although pain relief medication is helpful in alleviating pain, they also have side effects such as nausea, dry mouth, constipation and drowsiness. There are complementary approaches that may help alleviate pain including massage, gentle exercise, physiotherapy and, where legal, cannabis.

Pain is extremely prevalent in persons with HIV and is very debilitating. A number of barriers to pain management such as lack of knowledge by health care providers, cultural barriers, shortage of drugs, fear of addiction and patients wanting to be “good patients” must be overcome in order to improve the quality of life for persons with HIV.