New Guidelines Issued for Managing Chronic Pain in HIV Patients

Recommended Opioid Pharmacologic treatments for Chronic Nonneuropathic Pain in PLWH (Table 4)

• The authors recommend a time-limited trial of opioid analgesics for patients who do not respond to first-line therapies, report moderate-to-severe pain, and experience functional impairment.

Recommended Approach for Assessing Likelihood of Developing Negative, Unintended Consequences of Opioid Treatment in PLWH

• All patients should be assessed for potential risk of developing misuse, diversion, and addiction prior to prescribing opioids

Recommended Approach to Safeguarding PLWH Against Harm While Undergoing Treatment of Chronic Pain with Opioids

• The authors recommend routine monitoring and an “opioid patient-provider agreement (PPA).” (Table 5)

Recommended Methods to Minimize Adverse Effects from Chronic Opioid Therapy in PLWH

• The authors offer recommendations regarding storage of medication, patient education, and drug-drug interactions. (Table 6)

Recommended Approach to Prescribing Controlled Substances for Chronic Pain to PLWH and History of Substance Abuse Disorder

• The authors recommend careful evaluation and risk stratification. Those with a history of addiction for whom the risks outweigh benefits should have their pain “reasonably managed by other therapies” and also receive emotional support, close monitoring/reassessment, and linkage to addiction treatment and mental health services. They emphasize that a history of addiction or substance abuse disorder is not an absolute contraindication to receiving controlled substances and a universal precautions approach should be applied uniformly to patients.

Recommended Approaches to Pharmacologic Management of Chronic Pain in PLWH Who are Taking Methadone for Opioid Use Disorder

• The authors recommend a sign release, an initial screening protocol, dosing, and alternative strategies if prescribing additional methadone is contraindicated. (Table 7)

Recommended Approaches to Pharmacologic Management of Chronic Pain in PLWH Who Are Taking Buprenorphine for Treatment of Opioid Use Disorders

• Clinicians should use adjuvant therapy for mild-to-moderate pain, increase dose of buprenorphine, consider switching to transdermal formulation, and consider adding other opioid agent. (Table 8)

Recommended Screening Instruments for Common Mental Health Disorders in PLWH

• The authors recommend reviewing a patient’s baseline mental health status for modifiable factors that affect successful pain management, use specific screening instruments, and recommend a full neuropsychiatric evaluation. (Table 9)