What Is HIV Pain & How To Manage Pain in HIV?

HIV; one word or one catastrophe in a person’s life, mapping out months and years of torture, pain, misery and sufferings through a collection of diseases under one name; AIDS.

The Human immunodeficiency virus or HIV swarms a multitude of host cells, which in one way or another cause pain. Pain in HIV is rarely acute and is usually found in chronic carriers of HIV.

HIV carriers do not necessarily develop Acquired Immunodeficiency Syndrome (AIDS) but may complain of pain secondary to trauma, injuries and infections. Carriers of HIV are liable to developing several infections due to decreased immunity. Infections in places such as the external auditory canal, the nasal vestibule, the epidermis of the skin, the mucosa of the gastrointestinal tract are rich in nociceptors, which are sensitive to pain stimulation.

An acute infection in such areas is very painful due to tight adherent skin with the underlying cartilage or the mucosa with the submucosal (adhesions). This impedes blood flow and predisposes the area for an infarction and subsequent necrosis. Chronic infections are comparatively less painful.

Injuries such as contusions, lacerations, tears, fractures and dislocations in HIV carriers are very painful. Reduced immunity exaggerates an immune response leading to acute inflammation which stimulates pain in the affected area and prolongs pain in HIV carriers due to failure of the inflammation to resolve. The nociceptors are over-stimulated increasing the intensity and duration of pain following an injury.

Medicines usually cause pain as an unpleasant side-effect. People infected with HIV are put on several medicines, some used prophylactically, whilst some are used to control the growth of the virus or prevent infections from developing in the body following infection by HIV. Medicines now obsolete, used to treat HIV, are known to cause peripheral neuropathy, which is a classic finding in the pain pathway observed in HIV. Damage to nerves cause long-term irritation in the conduction of signals and cause fatigue of synapses which delays the healing process and elicits chronic HIV pain.

HIV infections cause damage to nerves all around the body, more specifically to the peripheral nerves known as peripheral neuropathy. This is results in inflammation of the nerve fibers leading to a specific type of pain known as HIV-pain. This denotes a pain caused due to auto-stimulation of pain nerve receptors due to damage of nerves or neurons. This HIV pain can be easily regarded as a complication of HIV infection. Peripheral neuropathy or HIV neuropathy is felt and indicated in patients in different ways. It can present as anesthesia, tingling sensations, cramping, muscle weakness, wasting and so forth.

Pain in HIV needs to be catered and managed skillfully. It is essential to lay down treatment plans which shall work in two ways

• Firstly, relieve pain of the HIV patient and carrier.
• Secondly, prevent the development of complications of both the medicines and the HIV infection itself.

An extensive treatment plan can be worked out to manage HIV pain including general pain killers, opioids, NSAIDs, steroids or morphine as a last resort to relieve HIV pain.

HIV pain that is bearable and presents during the early stages of the disease need not be treated with medication. Mild HIV pain can waited upon to either develop in severity or resolve on its own before attempting to treat it. If the HIV pain resolves on its own, it usually indicates the infection or inflammation has subsided or become latent. If the HIV pain persists, it gets termed as chronic pain, which needs to be investigated into and also needs to be treated adequately.

The easiest and primary way of managing HIV pain is to identify the cause of the pain. HIV carriers and patients use several medicines for different purposes some of which have the potential to cause an atopic reaction or may elicit a hypersensitivity response causing pain in an aggravated state. To get rid of such HIV pain, patients should discontinue medicines, which have adverse side-effects and are becoming the cause of their additional pain when suffering from HIV. Patients should consult their physician and either get their medicines replaced or discontinue them immediately.

Over the counter drugs such as paracetamol (Panadol), ibuprofen, aspirin should be taken to relieve severe and sudden bouts of pain in patients with HIV. Acute HIV pain attacks can be relieved easily by taking such medicines or pain killers on a timely basis. However, such medicines are contraindicated in cases of liver and kidney problems. Such medicines that treat mild pain are referred to as non-opioid pain killers.

HIV pain that does not reduce with mild pain killers and persists for a long period of time should be consulted by a doctor. The doctor shall investigate into the complications of HIV and distinguish between patients with acute and chronic HIV pain. After proper consultation, targeted pain killers to manage HIV pain can be prescribed and used.

Topical anesthetics (local anesthetics) and opioid pain killers are like Plan B medications in managing HIV pain. Opioids are the strongest pain-relieving agents, which directly disable the pain receptors and completely block all synapses and prolong action potentials by increasing the threshold of stimulation in such patients. Anesthetics help in relieving tingling and numbness along with pain and are used intradermally or subcutaneously in the form of creams and patches. Opioids on the other hand are the strongest and most potent pain killers. They have limited effect in chronic HIV pain though. Ideal examples of opioids include morphine and methadone. They are known to be used as a last resort to combat severe HIV pain.

When pain in HIV surpasses the tolerance limit of patients and reaches levels of disabilities, it requires rehabilitation. This is achieved through physiotherapy, nursing sessions, psychological therapies (counseling) and targeted approaches towards HIV pain.

Pain can prove to be a nuisance for HIV patients, which if not managed well, can cause social and physical impairments for patients along with fatal consequences. Pain management in HIV is an equally important task, as is the treatment of the disease itself.

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Also Read:

• Human Immunodeficiency Virus (HIV) Infection / AIDS: Symptoms, Topical Treatment, NSAIDs
• Retrovirus or HIV Infection: Transmission, Treatment, Clinical Manifestation, Prevention, Opportunistic Infections
• Symptoms and Stages of HIV
• Opportunistic Infections and Their Relationship with HIV/AIDS
• HIV Life Expectancy: How Long Can Someone Live With HIV?
• Timeline of HIV Symptoms