People living with HIV often experience chronic, or long-term, pain. However, the direct causes of this pain vary. Determining the possible cause of HIV-related pain may help narrow down treatment options, so it’s important to talk about this symptom with a healthcare provider.

People living with HIV may experience chronic pain because of the infection or the medications that treat it. Some factors that can cause pain include:

  • inflammation and nerve damage caused by the infection
  • lowered immunity from the effects of HIV infection on the immune system
  • side effects of HIV medication

Pain caused by HIV is often treatable. However, HIV-related pain is often underreported and goes untreated. Being open about this symptom enables healthcare providers to find the direct cause and coordinate a treatment plan for pain that works in conjunction with HIV treatment.

Treating chronic pain related to HIV requires a delicate balance between relieving pain and preventing complications. Many HIV medications can interfere with pain medications and vice versa. Also, HIV-related pain can be more difficult to treat than other types of chronic pain.

Healthcare providers must consider the following factors when recommending a treatment for HIV-related pain:

  • medications being taken, including over-the-counter drugs, vitamins, supplements, and herbal products
  • HIV infection treatment history
  • history of medical conditions in addition to HIV infection

Some medications may heighten pain sensitivity in people with HIV. Because of this, a healthcare provider might first recommend stopping certain medications or reducing the dosage to see if that helps resolve pain.

However, a person with HIV should never stop taking any prescription medication without first consulting their healthcare provider.

If stopping or reducing certain medications doesn’t work or isn’t possible, one of the following pain medications may be recommended:

Non-opioid pain relievers

Mild pain relievers, such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin (Bufferin) or ibuprofen (Advil), can treat mild pain. People who want to try this option should talk with a healthcare provider first.

A word of caution: Overuse of these medications can cause damage to the stomach, liver, or kidneys.

Topical anesthetics

Topical anesthetics, such as patches and creams, can provide some relief in people with mild to moderate pain symptoms. But topical anesthetics can interact negatively with some medications, so a healthcare provider should be consulted before using them.

Opioids

Opioids can temporarily help relieve symptoms of moderate to severe HIV-related pain. Only a short course of opioids should be used to treat acute worsening of pain; opioids aren’t recommended for chronic pain.

These types of medications include:

Treatment with opioids may be problematic for some people. Taking these medications as prescribed is critical in order to avoid issues such as opioid misuse and addiction.

HIV neuropathy is damage to the peripheral nerves resulting from HIV infection. It causes a specific type of HIV-related pain. Peripheral neuropathy is one of the most frequent neurologic complications of HIV infection. It’s been associated with some of the older treatments for HIV. Symptoms of this condition include:

  • numbness in the extremities
  • unusual or unexplainable sensations in the hands and feet
  • painful sensation without a cause that can be identified
  • muscle weakness
  • tingling in the extremities

To diagnose this condition, a healthcare provider will ask what symptoms are occurring, when they started, and what makes them better or worse. The answers will help shape a treatment plan based on the cause of the pain.

It’s important for an HIV-positive person who is experiencing pain to speak to their healthcare provider about it. There are many causes of HIV-related pain. It can be difficult to treat, but relieving it is often possible. A healthcare provider can help identify the factors that are causing pain, which is the first step in finding the right treatment.