Abstract
Chronic pain management has become a treatment priority for people living with HIV (PLH), and PLH may be at increased risk for opioid addiction. Physical therapy (PT) has been shown to be effective as a nonpharmacological method of chronic pain management; however, there is a gap in research examining the role of PT for chronic pain, especially as it relates to opioid reduction, in this patient population. This retrospective study evaluated pain level and opioid use before and after PT intervention among HIV-positive adults with chronic pain on chronic opioid therapy (n = 22). The study was conducted at a multidisciplinary AIDS clinic in Atlanta, GA. Outcome measures were self-reported pain on the numerical rating scale (0–10) and morphine milligram equivalents (MMEs), which measure opioid use. A majority of patients (77%) demonstrated a decrease in pain by the conclusion of the study period; however, only 18.2% of patients reported decreased pain as well as a decrease in MMEs. The most common PT treatments used among the patients with a decrease in pain and/or opioid use included home exercise programs, manual therapy, and self-pain management education. Eighty percent of the participants who did not decrease opioid use reported a decrease or elimination of pain by the end of the PT intervention. This reflects the need for careful consideration of the complexity of opioid use and addiction, and the importance of a multidisciplinary team to best serve the needs of PLH aiming to decrease chronic pain and opioid use.
Highlights
20% of adults suffer from chronic pain in the United States, costing an estimated $635 billion in both direct and indirect costs.[1,2] In their 2017 report Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With HIV, the HIV Medical Association stated that current estimates of chronic pain range from 39% to 85% among people living with HIV (PLH), as compared with 11% in the general population.[3]
This study aimed to identify which specific Physical therapy (PT) modalities and interventions are most effective in decreasing chronic pain and decreasing opioid use among PLH currently receiving chronic opioid therapy
Materials and Methods This retrospective study investigated the effectiveness of a targeted PT intervention with the end-point of decreasing pain reports and opioid use among PLH enrolled at a large multidisciplinary AIDS clinic in the southeastern United States
Summary
20% of adults suffer from chronic pain in the United States, costing an estimated $635 billion in both direct and indirect costs.[1,2] In their 2017 report Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With HIV, the HIV Medical Association stated that current estimates of chronic pain range from 39% to 85% among people living with HIV (PLH), as compared with 11% in the general population.[3]. There is a complex history of opioid use disorder, substance abuse history, and pain management in the United States. The standard of care for chronic pain has historically been a pharmacological approach that heavily included the use of opioid analgesics.[4,5,6] Recent federal guidelines have outlined recommendations for pain mitigation in the context of the ongoing opioid epidemic. The Centers for Disease Control and Prevention (CDC)’s Guideline for Prescribing Opioids for Chronic Pain reports that there is no evidence to a Sara D.
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