Pain management for the AIDS patient

The relief of pain in persons with HIV disease, while similar to other patient populations such as cancer patients, has some unique aspects. Pain must be a focus, and a priority, of care in persons with HIV disease along with treatment of the underlying HIV infection and the complications of immune compromise. Pain in patients with AIDS is very prevalent and often undertreated. Pain contributes to psychological and functional morbidity in AIDS. At the present time, the guidelines developed for treatment of cancer pain are used in patients with HIV disease, with the recognition that neuropathic pain should be treated differently from nociceptive pain. A multidisciplinary approach to pain management is optimal; however, consultations with pain specialists are adequate for management of pain in most patients, including those with HIV disease. Approaches to management of pain in patients with HIV disease are: Localize and characterize pain Work up possible etiologies Rule out infections and malignancies Be aware of multiple etiologies Explore the psychological/emotional contribution to pain Perform a thorough history and physical examination including medication history, history of substance use/abuse, and neurological and psychological assessments Treat the medical and psychological causes of pain Use appropriate pain medications in adequate doses Consult specialists in pain management, when necessary.