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Introduction Principles Management NRTI Info NNRTI Info
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Coformulation Antiretroviral Therapy
Investigational Adherence Lab Evaluation Resistance Tests PEP
Antiretroviral Tables OI Prevention Vaccinations TB Therapy Hepatitis Therapy
OI Diagnosis OI Therapy Bibliography Links Palliative Therapy

 

Palliation and Pain Control in HIV/AIDS


 

Direct Links to Palliative Care Info
Palliation & Pain Control in HIV/AIDS
Painful Conditions
Palliative Care Medication Use
Non-Opiate Pain Management
Opiates for Acute Pain
Opiates for Chronic Pain
Equianalgesic Dosing of Opiates
Pain Management Guidelines
Algorithm for Initiation of Chronic Pain Therapy
Guidelines for Chronic Pain Therapy in Chemically Dependent Patients
Non-Pain Symptom Management Guidelines
Constipation
Nausea
Fatigue & Sedation due to medical therapy

 


HIV and AIDS are associated with several uniquely painful conditions.  See the table below.

 

Painful Conditions Associated with HIV Infection & AIDS
Condition Cause Considerations & Treatment Basics
Herpes zoster - acute Eruption of latent varicella zoster virus along a nerve root in a dermatomal distribution Treat with high dose oral or IV acyclovir, valacyclovir, famciclovir until lesions are crusted.

For analgesia consider:

Gabapentin
Opiates
Wound care similar to burn
Post herpetic neuralgia Nerve damage after herpes zoster For analgesia consider:

Gabapentin, levetiracetam
Opiates
Lidocaine patches
Rarely nerve blocks are performed.
Distal sensory polyneuropathy HIV infection

Mitochondrial toxicity of antiretroviral drugs

Other drugs including isoniazid in the setting of pyridoxine deficiency

 Rule out vitamin B-12, folate deficiency, thyroid disorders, and syphilis.  Consider nerve biopsy for equivocal cases.

 

For analgesia consider:

Gabapentin, levetiracetam, pregabalin
Opiates
Lidocaine patches
Duloxetine
Neoplastic disease Kaposi's sarcoma
Lymphoma		 For analgesia consider:
Gabapentin
Opiates
Rarely corticosteroids may be beneficial to relieve inflammation and swelling.
Apthous stomatitis / esophagitis HIV infection

Idiopathic

 Biopsy for histopathology and culture is important.

 

For analgesia/therapy consider:
Triamcinolone in Orabase applied to ulcers 2-3 times per day.
Sucralfate suspension swish and swallow or tablets (in paste form) applied 2-3 times per day
Prednisone 40-60 mg per day and gradually tapered after response is achieved.
Thalidomide for refractory cases

 

Also consider pain control with opiates if necessary.
Esophagitis Candida species

Histoplasmosis
Cytomegalovirus

Herpes simplex

Carcinoma
Idiopathic (apthous)

 Treat microbiologic etiology after appropriate workup usually including esophagoscopy and biopsies

 

Also consider pain control with opiates, viscous lidocaine, sucralfate
1. Chronic headaches

2. Chronic back pain

3. Degenerative joint disease

4. Chronic postoperative pain

5. Traumatic injuries
6. Miscellaneous pain

 Multiple causes, sometime co-existent

Self-explanatory

 This catch-all category is growing more prevalent as persons with HIV live longer.
Treat specific etiology if possible after careful workup in all cases.
Surgery, physical therapy, massage, stress reduction, meditation, exercise, NSAIDs, opiates, adjuvants, nerve blocks, TENS, topical anesthesia should all be considered.

 

 

Quick Menu / Table of Contents
Introduction Principles Management NRTI Info NNRTI Info
PI Info Fusion Inhibitors Coreceptor Inhibitors Integrase Inhibitors Drug Summary
Coformulation Antiretroviral Therapy
Investigational Adherence Lab Evaluation Resistance Tests PEP
Antiretroviral Tables OI Prevention Vaccinations TB Therapy Hepatitis Therapy
OI Diagnosis OI Therapy Bibliography Links Palliative Therapy

 

Updated 2/10/2013