HIV-Related Pain

Assessing Pain

The goals of pain assessment are to:

1. Define the severity of pain (how much it hurts): Your health care provider may ask you to assign a number to your pain, from one (very mild pain) to ten (the worst possible pain). Pictures can also describe pain. A smiling face represents little or no pain, while a crying face represents severe pain.
2. Describe details of your pain: Your health care provider may ask you to describe how your pain feels, for example sharp, dull, throbbing, or burning. Is it new (acute) or have you had it for a while (chronic)? Where is it located? Is it constant, or does it come and go?

You may be having pain and do not want to complain about it. However, pain is your body's way of telling you that something is wrong. Talking to your health care provider about how you feel is not complaining -- it is the best thing you can do to find out what is wrong and get the right treatment.

Pain Management

Once the type and characteristics of pain are identified, you and your health care provider will decide how to manage or treat it. The following factors will play a role in choosing the right type of treatment for you:

• Cause, type, and severity of pain
• Whether it is short-term or long-term
• Whether you have ever used drugs (substance abuse) and what you have used

If your pain is being caused by a medication you are taking or another illness, your health care provider may want to take care of that first. If you are still experiencing pain, there are many options for pain relief.

Non-Medicinal Therapies

Pain relief options without medications include:

• Massage
• Relaxation techniques, such as meditation
• Physical therapy
• Acupuncture
• Heat and cold therapy
• Hypnosis
• Mental imagery or visualization
• Regular physical activity

Many of these options -- such as massage, acupuncture, meditation, and exercise - trigger the body to release endorphins. Endorphins are brain chemicals that act similarly to opiate drugs like morphine and codeine. While these may be enough to relieve pain by themselves, they are often used along with pain medications.

Non-Opioid Medications

Pain relief medicines that do not contain narcotics (opiates). These are available over-the-counter or by prescription. These medicines relieve mild to moderate pain related to inflammation or swelling. Some people with a history of drug addiction prefer these non-opioid pain medicines. They include:

• Tylenol (acetaminophen)
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (for example Advil)
• COX-2 inhibitor, a type of NSAID that is less likely to cause stomach problems, for example Celebrex (celecoxib)
• Steroids, which are natural or manufactured hormones that reduce inflammation. Examples include prednisone and hydrocortisone.

Non-opioid pain medicines can cause side effects including liver damage (Tylenol), easy bleeding (aspirin), stomach pain or damage (aspirin and other NSAIDs), heart problems (COX-2 inhibitors), and high blood sugar and bone weakening (steroids).

Opioids/Narcotics

Narcotics and related drugs known as opioids are the strongest pain relievers, available only by prescription. They are used to treat moderate to severe pain.

Opioids are classified by how fast and how long they work.

• Immediate release opioids -- act rapidly but pain relief lasts for a shorter period of time
• Sustained-released opioids -- take longer to start working but pain relief lasts longer

Opioids are also classified by their strength.

• Mild to moderate pain relievers (they are often mixed with non-opioid medicines to improve their action):
  • Hydrocodone
  • Vicodin (hydrocodone plus acetaminophen)
  • Codeine
  • Tylenol with codeine (acetaminophen plus codeine)
  • Ultram (tramadol)
• Severe pain relievers:
  • Morphine
  • Duragesic (fentanyl)
  • OxyContin (oxycodone)
  • Dilaudid (hydromorphone)
  • Methadone or Buprenorphine (reserved for treatment of pain that does not respond to other pain relievers)

Opioids can cause side effects including drowsiness, nausea, and constipation. Overdoses can slow down breathing and cause death. Opiates can lead to dependence or addiction and may be a problem for people with a history of substance use.

Topical or Local Therapies

These are medications that are injected or applied to the skin around a painful area. Examples include the local anesthetic Xylocaine (lidocaine) and capsaicin, which comes from chili peppers.

Other Therapies

There are medicines prescribed for other purposes that also have pain-relieving properties.

• Anti-depressants -- relieve neuropathic pain such as peripheral neuropathy. An example is Cymbalta (duloxetine).
• Anti-convulsants -- usually used to treat seizures. Some of these drugs help with peripheral neuropathy and herpes pain. Examples include Neurontin (gabapentin), Tegretol (carbamazepine), Topomax (topiramate), and Trileptal (oxycarbazepine).

Determine if the Pain Treatment Works

Once you start medication or other pain treatment, your health care provider will likely check your pain regularly to see if treatment is working. Sometimes pain medications can stop working over time.