Evidence-based pain guidelines in HIV care

Despite advances in HIV treatment, pain continues to be a prevalent symptom experienced by persons living with HIV (PLWH) and is associated with sleep disturbance and lower quality of life. Ongoing assessments guide effective pain management. Substance abuse issues and concerns about diversion complicate pain treatment. We reviewed the evidence of current research related to pharmacological and nonpharmacological interventions for pain. A comprehensive review of the literature was conducted, including randomized controlled trials, meta-analyses, evidence-based clinical practice guidelines, and expert opinion; studies of HIV neuropathy and pediatric populations were excluded. We limited the search to English language and human studies. While pharmacology-based interventions are widespread, their efficacy over the long term is questionable. Nonpharmacological therapies are promising and require further study. Aberrant behaviors related to opiates are common in PLWH; expert guidelines to address them are presented. A case study is included to illustrate an application of evidence-based clinical practice.