HIV Related Pain

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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 person 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 you 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 following:

  • 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 itself, 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 digestive 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 (womb), cervix (opening to the womb), 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 PainHerpes 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.
  • Other Types

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. For more information, see The Well Project's article on Complementary Therapies.

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 (e.g., Advil)
  • COX-2 inhibitor, a type of NSAID that is less likely to cause stomach problems, e.g., 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 grouped or 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. Some examples are Pamelor (nortriptyline) and 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.

What to Do if You Have Pain

When you experience pain, it is important to know how to get fast, safe relief.

  • 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 long run.
  • 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 it.
  • 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 be fatal. 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 medication.

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 of life.

Additional Resources

Select the links below for additional material related to HIV and pain.

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