[Pain from AIDS (adult)].

Abstract

Pain, a major handicapping factor for HIV patients, has been underestimated and insufficiently treated. The pain may have various origins, including the virus itself, antiviral or anticancer treatments, secondary infections or their treatments, or unrelated intercurrent infection. Just as in the general population, three types of pain may be distinguished: nociceptive, neuropathic, and idiopathic. The lesions capable of producing nociceptive pain are numerous in HIV patients. The most common etiologies are oropharyngeal, gastrointestinal, and rheumatic. Neurological complications are among the most frequently encountered in the course of HIV infection, and some may cause typical neuropathic pain. Such pain may be secondary to a central lesion, as in cerebral toxoplasmosis, but usually is related to a peripheral effect. The principal etiologies of peripheral neuropathic pain are HIV neuropathies, postherpetic neuralgia, toxic neuropathies secondary to antiviral treatment, and diabetic neuropathies. Pain management should be part of the treatment of HIV complications. In the absence of a validated protocol for treatment of HIV-related pain, the guidelines for cancer pain management developed by the World Health Organization can be used as a starting point for nociceptive pain. Dosage and administration should be individually adjusted. Treatment of neuropathic pain is based primarily on tricyclic antidepressants and anticonvulsants. Nonpharmaceutical interventions such as transcutaneous electric stimulation, hypnosis, and acupuncture may also be useful. Evaluation and management of psychological factors should be an integral part of treatment, as in all patients with chronic pain.