Pharmacological pain control for human immunodeficiency virus–infected adults with a history of drug dependence

Abstract

Clinicians treating human immunodeficiency virus (HIV)-infected patients with substance use disorders often face the challenge of managing patients' acute or chronic pain conditions while keeping in mind the potential dangers of prescription opiate dependence. In this clinical review, we critically appraise the existing data concerning barriers to appropriate treatment of pain among HIV-infected patients with substance use disorders. We then analyze published studies concerning the choice of pharmacological pain control regimens for acute and chronic pain conditions in HIV-infected patients, keeping in mind HIV-specific issues related to drug interactions and substance use disorders. We summarize this information in the form of flowcharts for physicians approaching HIV-infected patients who present with complaints of pain, providing evidence-based guidance for the structuring of pain management services and for addressing aberrant drug-taking behaviors.

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

“…Since 2004, a number of articles and chapters have been published outlining suggested strategies for the management of acute pain in the patient taking long-term opioids for both chronic non-cancer pain or because they have an addiction disorder and are in a drug treatment program (Carroll et CHAPTER 11 Alford et al, 2006;Hadi et al, 2006;Mehta & Langford, 2006;Rozen & DeGaetano, 2006;Basu et al, 2007;Ludlow et al, 2007;Macintyre & Schug, 2007;Roberts, 2008).…”

“…It is usually given once a day, which is often enough to suppress symptoms of opioid withdrawal; the duration of any analgesic effect from the dose is likely to be much shorter (Alford et al, 2006;Basu et al, 2007). Dividing the daily dose on a temporary basis (eg giving the methadone in two equal doses twice a day) may allow some of the analgesic effect to be seen.…”

Clinical Care of the HIV-Infected Drug User

“…Additionally, HCV and HIV, as well as, HIV therapy can cause peripheral neuropathy. Diagnosis and treatment is often complicated by difficulties in pain management and has been reviewed elsewhere [60].…”

“…Active drug use has been linked to nonadherence [56,57], and, despite similar rates of HIV disease progression during the pre-HAART era, progression has been reported to be higher among injection drug users than among persons who do not use mind-altering substances in the HAART era [58][59][60][61].…”

Epidemiologie und Therapie von Schmerzen und Depression bei HIV und Aids

“…Diese HIVin fizierte Gruppe wird schmerztherapeu tisch noch schlechter versorgt und weist eine signifikant größere Prävalenz von Schmerzen und psychosozialen Proble men auf als die übrigen HIVInfizierten. Auch besteht eine Korrelation zwischen der Anzahl der verschiedenen Schmerz syndrome und dem immunologischen Status [6,54] Etwa 85% der Patienten mit Schmer zen bei HIV und Aids erhalten eine inadä quate Therapie, und Koanalgetika wer den nur bei 10% eingesetzt. Die Patienten, die die HIVInfektion durch Drogen gebrauch akquiriert haben, werden wie Frauen und Patienten mit niedrigem Bil dungsstand schlechter schmerztherapeu tisch versorgt.…”