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Pain is common in people living with HIV (HIV+ people). One study found that
more than half of HIV+ women had pain in the last six months. Pain can occur at
all stages of HIV disease and can affect many parts of the body. Usually pain
occurs more often and becomes more severe as HIV disease progresses. But each
individual is different. While some people may experience a lot of pain, others
have little or none.
What Causes Pain?
HIV related pain may be:
- A symptom of HIV itself
- A symptom of other illnesses or infections
- A side effect of HIV drugs
Regardless of its cause, pain should be evaluated and treated to help HIV+
people have a good quality of life.
Common Types of Pain
The first step in managing HIV related pain is identifying the type, and if
possible, the cause of pain. Some common types of pain include the
Peripheral Neuropathy -- Pain
due to nerve damage, mostly in the feet and hands. It may be described as
numbness, tingling, or burning. Nerve damage can be caused by HIV drugs or
other medical conditions such as diabetes. The older HIV drugs that caused the
most peripheral neuropathy are not commonly used today.
Abdominal Pain -- There are
many possible causes of abdominal pain (pain in the stomach area):
- A side effect of some HIV drugs (for example, cramps)
- Infections caused by bacteria or parasites
- Problems of the intestinal tract such as irritable bowels
- Inflammation of the pancreas (pancreatitis) can caused by some HIV drugs,
high levels of fat in the blood, or drinking alcohol
- Bladder or urinary tract infections (especially in women)
- Menstrual cramps or conditions of the uterus, cervix, or ovaries
Headache -- Head pain can be
mild to severe, and may be described as pressure, throbbing, or a dull ache.
The most common causes of mild headaches include muscle tension, flu-like
illness, and HIV drug side effects. Moderate or severe headaches can be caused
by sinus pressure, tooth infections, brain infections, brain tumors, bleeding
in the brain, migraines, or strokes.
Joint, Muscle, and Bone Pain --
This pain can also be mild to severe. It may be related to conditions such as
arthritis, bone disease, injury, or just aging. It can also be a side effect of some HIV drugs and medications for
other conditions like hepatitis or high cholesterol.
Herpes Pain -- Herpes is a family of viruses common in HIV+ people. Herpes viruses stay in
the body for life, going into hiding and flaring up later. The varicella-zoster
herpes virus first causes chickenpox and later can cause shingles, a painful
rash along nerve pathways. Herpes simplex virus types 1 and 2 cause painful
blisters around the mouth ("cold sores") or genital area. Even after a herpes
sore heals, a person may still have persistent pain.
- Painful skin rashes due to infections or HIV drug side effects
- Chest pain caused by lung infections such as TB, bacterial pneumonia, or PCP pneumonia (Pneumocystis pneumonia)
- Mouth pain caused by ulcers ("canker sores") or fungal infections like thrush
- Fibromyalgia or related chronic pain conditions
- Pain due to cancer anywhere in the body
The goals of pain assessment are to:
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.
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
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.
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
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.
Pain relief options without medications include:
- Relaxation techniques, such as meditation
- Physical therapy
- Heat and cold therapy
- Mental imagery or visualization
- Regular physical
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.
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
Narcotics and related drugs known as opioids are the strongest pain
relievers, available only by prescription. They are used to treat moderate to
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
Opioids are also classified by their strength.
- Mild to moderate pain relievers (they are often mixed with non-opioid
medicines to improve their action):
- Vicodin (hydrocodone plus acetaminophen)
- Tylenol with codeine (acetaminophen plus codeine)
- Ultram (tramadol)
- Severe pain relievers:
- 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.
There are medicines prescribed for other purposes that also have
- 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
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.
What to Do if You Have Pain
When you experience pain, it is important to know how to get fast, safe
- Do not ignore your pain -- Pain is the body's way of telling us something is
wrong. Ignoring pain often makes matters worse and can cause more damage in the
- Assess your pain -- When pain occurs ask yourself the following questions:
- How long have I had the pain?
- Did it happen suddenly or over time?
- Is the pain sharp or dull?
- What makes the pain worse?
- Does anything ease the pain?
- Is the pain limited to one place or does it spread out to other areas?
- Are there other symptoms (for example numbness, cough, or fever)?
- Tell your health care provider -- Report pain to your provider without
delay. Describing your pain will help find the cause and how best to treat
- Take your pain medicine as directed -- If you need pain medications, make
sure you take them exactly as prescribed. Pain medications work best if they
are taken at the first sign of pain. Waiting until the pain is very bad before
taking pain medicine, or "toughing it out" is not helpful. In fact, waiting
almost always results in your needing to take more pain medication than if you
had begun taking it at the first sign of pain.
- Be responsible -- Pain medications are very effective when taken as
prescribed. Taking them incorrectly can be dangerous. Opioids are addictive,
meaning you can develop physical and emotional dependence on a drug. High doses
can cause breathing problems. In the worst cases, incorrect use of opioids can
Opioids are also controlled substances, which means their distribution,
possession, and use are controlled by the government. It is illegal in the US
to sell or share your opioid pain medications with others.
- Tell your health care provider if treatment does not work -- If your pain
medicine is not relieving your pain, talk to your providers. You may be taking
a medication that will not work for you, or you may have built a tolerance to
the drugs over time. You may need to change doses or switch to a new
Pain is common among HIV+ people. However, it can be managed using a variety
of methods. Talk to your health care provider if you are having pain. He or she
can work with you to find the cause, manage the pain, and improve your quality