Efficacy of a vibratory stimulus for the relief of HIV-associated neuropathic pain

Abstract

Pain related to HIV disease is frequently debilitating. Of the many pain syndromes that occur in persons with HIV, distal symmetrical polyneuropathy (DSPN) is particularly devastating. Because DSPN often responds, at best, only partially to available pharmacologic interventions, non-pharmacologic interventions need to be investigated. Vibration has been suggested to be effective for reducing pain in other populations with chronic pain. This randomized, sham-controlled, double-masked study tested the short-term efficacy of a 45-min vibration treatment for DSPN foot pain in persons infected with HIV. Vibration therapy was delivered using a portable platform foot vibrator that provided stimulation at a frequency of 60 Hz. For all patients, the control box for the vibrator emitted an audible hum and part of the control box lit up during treatment, but only patients randomized to active treatment received vibration. Pain intensity (0-10) was measured immediately prior to and after treatment. Subjects were also questioned regarding pain relief (0-100%) immediately after the treatment. The mean percentage pain relief was 61.0+/-33.1% (median 70.0; range 0-100) for all patients, 67.3+/-34.0% (median 80.0; range 0-100) for vibration patients, and 55.0+/-32.0% (median 60.0; range 0-100) for sham patients. No statistically significant differences were found between the vibration and sham groups with respect to percentage pain relief (Mann-Whitney test; P=0.19) or the pre- and post-treatment current-pain difference (Mann-Whitney test; P=0.92). These results underscore the necessity for control groups in studies of non-pharmacologic therapies for pain.

Mitochondrial toxicity and HIV therapy

“…74 In addition to treatment with analgesics, tricyclic antidepressants, and topical anaesthetics specific interventions have been examined. Although recent studies of recombinant human nerve growth factor 77 and vibratory stimuli 78 have not shown significant eYcacy, a pilot study of lamotrigine reported some improvements in symptoms. 79 Famularo and colleagues noted that 12 HIV infected patients with peripheral neuropathy on regimens including ddC, ddI, or d4T had acetyl carnitine deficiency compared with controls with no disease or non-drug related neuropathies.…”

Evidence-based pain medicine: The good, the bad, and the ugly

“…The link between low study quality and overestimation of treatment effect is now being extended to trials of nondrug and complementary pain therapies. 45,46 The US National Institutes of Health encourages RCTs to address clinical questions and provides educational materials for patients considering participating in RCTs. 47 Because it clearly and explicitly documents present knowledge in one area of pain therapy, highlights its many gaps and flaws, and presents steps to correct these, the report by Geurts et al cannot be viewed as a "failed" meta-analysis.…”

Multi-centred mixed-methods PEPFAR HIV care & support public health evaluation: study protocol

“…The WHO pain ladder [33] outlines the need for non-opioid and opioid analgesics until pain has been controlled. Neuropathic pain, which is particularly common in HIV [34] is caused by damage to nerves and does not respond to traditional pain medication.…”