Non-Pharmacological Interventions Addressing Chronic Pain in People Living with HIV

Chronic pain affects 25-85% of people living with HIV (PLWH), negatively impacting health behaviors and HIV health outcomes. While opioids are frequently prescribed for pain, there are concerns about side effects and addiction potential, and the current consensus guideline advises against their use as a first-line pain management for this population. Therefore, there is an increasing need for non-pharmacological alternatives and adjunctive interventions. This review aims to examine the characteristics, efficacy, and limitations of existing non-pharmacological approaches to chronic pain management in PLWH to inform clinical practices and future research.

A comprehensive literature search identified 13 clinical trials employing cognitive-behavioral techniques, stress management, positive affect enhancement, and complementary medicine approaches (e.g., yoga, acupuncture, hypnosis). These interventions generally showed significant effects with respect to reducing pain intensity and interference in PLWH, with some also addressing and improving depression, substance use, or antiretroviral medication adherence. However, some were pilot trials and others lacked robust methodologies or sufficient follow-up regarding the ability to definitively determine the durability of these benefits. Existing non-pharmacological interventions have potential in addressing pain and related functional impairment in PLWH, such as substance use and emotional well-being. Future research should explore the underlying mechanisms of these interventions and better understand strategies to optimize and establish durability. Incorporating adherence counseling into these interventions could further enhance HIV outcomes by addressing the interconnected challenges of chronic pain and adherence to antiretroviral therapy (ART), thereby supporting both pain management and overall HIV care.