Polyneuropathy Case Studies

Management of Chronic Pain in Patient living with HIV Distal Sensory Polyneuropathy: a Case Report

Rashelle L. Salvatierra and

1Section of Pain Management, Department of Anesthesiology, Philippine General Hospital, University of the Philippines Manila

2Section of Pain Management, Department of Anesthesiology, College of Medicine and Philippine General Hospital, University of the Philippines Manila

Abstract

This case is about a 39 year old male with 11 year history of HIV who experienced polyneuropathy. He was continuously managed by specialists from the Infectious Department and other subspecialties including to Pain Management.

HIV distal sensory polyneuropathy is the most common neurologic complication of HIV. Symptoms include stabbing

In 2017, an estimated 36.7 million people were living with HIV with a global HIV prevalence of 0.8% among adults.1 In the Philippines alone, an estimated 56,000 people were infected with HIV.2

Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. Many of those infected suffer from peripheral neuropathy. Chronic pain remains a significant problem in persons living with human immunodeficiency virus and it is associated with psychological and functional morbidity, even in the absence of advanced disease complications. Chronic pain with HIV patients has a current prevalence ranging from 39% to 85% depending on the study.3 Pain is the second most common symptom in ambulatory settings where HIV disease is treated. Nearly half of that pain is neuropathic due to injury to the central or peripheral nervous systems from direct viral infection, infection with secondary pathogens, or side effects of

Moreover, nociceptive pain in HIV patients may also be present and these are caused by tissue injury as a result of inflammation (eg, autoimmune responses), infection (eg, bacteria, other viruses, tuberculosis), or even neoplasia (eg, lymphoma or sarcoma).

Historically, pain among person living with HIV has been undertreated.5-7 Thus medical providers, must be familiar with the evaluation and management of chronic pain. Although chronic pain management is recognized as a specialty discipline within medicine, many patients lack access to specialized pain management services and must rely on their HIV clinical providers to initially evaluate and address their chronic pain needs. Just as with cancer patients, pain management is an essential section of overall disease management for HIV