Login

Switch On Your HIV Smarts.

How the myth about opioids and chronic pain affects people living with HIV

, by Emily Land

Chronic pain is something many people living with HIV report, with studies estimating that the condition affects anywhere from 40% to 85% of people living with HIV. Many people are treated with long-term opioid therapy, and some studies estimate that as many as 17% of people living with HIV are treating their pain for long periods of time with medications such as Vicodin, OxyContin and the like.

OxyContinOur country is in the midst of an opioid epidemic, with skyrocketing rates of overdose deaths, dependence and other forms of substance misuse caused by powerful opioid painkillers. With “unclear benefits” of long-term opioid therapy for the treatment of pain, public health experts have questioned whether long-term opioid therapy causes more harm than good.

What are the benefits of long-term opioid use for people living with HIV, and what are the harms? To shed light on these issues, Jessica Merlin, MD, PhD, joins BETA from the University of Pittsburgh School of Medicine. Dr. Merlin is an infectious disease physician, an addiction specialist, and she runs a chronic pain clinic for people living with HIV.

BETA: Thanks for joining us Dr. Merlin. Could you first tell us about why people living with HIV have higher rates of chronic pain?

Jessica Merlin, MD, PhD

Jessica Merlin, MD, PhD

Jessica Merlin, MD, PhD: Chronic pain is really common in people living with HIV, but we really don’t know why people living with HIV seem to have so much chronic pain. One hypothesis is that chronic pain may be caused by inflammation, in the same way that cardiovascular disease may be caused by inflammation. It could be that the virus itself increases pain sensitivity—we have done some work suggesting that this might be the case. Or it could be that people living with HIV who experience chronic pain have other things happening in their life—mental illness or substance use—that may cause chronic pain.

Overall, I think the issue is underappreciated by the medical community. People living with HIV have been talking about chronic pain for a long time and only recently has the medical community really started to understand the importance of this health problem for people living with HIV.

You recently did a study with people living with HIV taking long-term opioid therapy. Can you tell us a little more about what you were researching?

Dr. Merlin: All of my research questions come from the clinic—I run a chronic pain clinic for people living with HIV. A lot of people in HIV primary care have relatively debilitating chronic pain, and a lot of people take long-term opioid therapy. There are studies that suggest that people living with HIV are more likely to be prescribed long-term opioid therapy.

As you know, in the last few years we’ve learned a lot about the risks of long-term opioid therapy, and the lack of benefit.

Back painI was interested in understanding chronic pain itself, as a comorbidity in people living with HIV. What’s the impact? Not only on function, but also on HIV outcomes. How does it impact virologic suppression and retention in care? These are things that are really important to find out as we look at keeping individuals living with HIV healthy.

Why did you hypothesize that long-term opioid therapy might influence retention in HIV care?

Dr. Merlin: There have been rumblings, for many years, that some HIV providers are prescribing long-term opioid therapy in situations where they otherwise might not—as an incentive to keep their patients retained in care. They might think that the patient—because they are getting long-term opioid therapy from them—is more likely to keep coming back. Or, we’ve heard that providers may say, “If you keep your virus suppressed (which means being adherent to medications) and if you come to the clinic, I’ll give you opioids.”

As a chronic pain specialist, and an addiction specialist, this really worries me.

If someone is doing great on their opioids, fine. But if someone has concerning behaviors, we’re not treating their addiction and their pain properly. The idea that opioid misuse is the “lesser of two evils” is really concerning.

What did your study find in terms of long-term opioid therapy and retention in care?

Dr. Merlin: The study we did was with a national clinic-based cohort of people living with HIV. A total of 2,334 people were included in the study—people without chronic pain, people with chronic pain who were on long-term opioid therapy, and people with chronic pain who were not on long-term opioid therapy.

We found that there was no difference in retention in care between the two groups of people with chronic pain—those who were on long-term opioid therapy and those that were not. If providers are keeping people on long-term opioid therapy just to keep them coming back to the clinic, not even raising the question of whether this is a medically indicated or safe thing to do, it’s not actually having the intended effect.

What more can you tell us about pain management with long-term opioid therapy, especially for people living with HIV?

Dr. Merlin: The evidence is pretty strong that opioids are not very effective in treating chronic pain. I don’t equate opioids with successful pain management.

This can be confusing for people, because for many years people have been told that opioids work for chronic pain. But this was based on little to no evidence. There’s an entire backstory about how this myth about opioids got propagated, and a lot of it was about how OxyContin was marketed. The bottom line is that it became the mission of many people to get opioids out there, and now we’re dealing with the aftermath.

Not only do opioids not work well, but they can cause a lot of problems. There’s risk of addiction, overdose, sexual dysfunction and long-term side effects like depression.

What kinds of therapies or treatments do you recommend for people living with HIV who experience chronic pain?

Dr. Merlin: The answer is really complicated, and individualized for each patient.

If a person is already taking opioids, we assess the risk and benefits of opioids for that person. Are they at risk for depression? Are they having trouble sleeping? Are they taking benzodiazepines too? It’s particularly dangerous to take benzodiazepines and opioids. We also assess the functional benefit people are getting from their opioids. If they’re still lying in bed all day, despite being on opioids, it doesn’t seem like they’re getting much functional benefit.

Some of the research I am doing now is to test a behavioral pain management intervention on a large scale. The intervention involves things like group sessions and one-on-one sessions. There is a peer-led session led by someone who is doing well in managing their chronic pain. We’ll be teaching people—what are the things you can do in your daily lives to put your pain in the background, and be able to do the things that make you, you?

One thing we definitely want to get the word out about is that chronic pain needs to be on the map as we’re thinking about the health of people living with HIV. It’s really common, it’s impairing, and it’s associated with much worse HIV outcomes.

Source:

Merlin, J. S. and colleagues. Brief Report: The Association of Chronic Pain and Long-Term Opioid Therapy With HIV Treatment Outcomes. JAIDS, September, 2017.

Resources:

San Francisco Health Network provides a list of resources for people living with chronic pain, including an online map-based tool to identify alternative and complementary pain management services, a list of low-cost integrative medicine for chronic pain, and a personal care plan for chronic pain. Zuckerberg San Francisco General Hospital offers consultations and pain management services.

 

Comments

13 Responses to How the myth about opioids and chronic pain affects people living with HIV

  1. gail chretien says:

    I’m Gail Chretien from United State , I contacted HIV in 2009, I was told by my doctor that there’s no possible cure for HIV. I started taking my ARV’s, My CD4 was 77 and viral load was 112,450. I saw a website of Dr. Agbebaku, also I saw a lot of testimonials about him on how he uses herbal medicine to cure HIV. I contacted him and told him my problems, He sent me the herbal medicine and I took it for 14 days which was two weeks,after then I went for check-up and I was cured. The medicine has NO SIDE EFFECT, there’s no special diet when taking the medicine. He also cure ALS, HEPATITIS B, CANCER, HERPES, DIABETES and lots more. here,s my contact +1(315) 795 1518 You can reach him on dragbebakuspellsolutiontemple@gmail.com. or call and WhatsApp [+2349053099479]. visit; https://www.facebook.com/naturalherbscureforhiv .

  2. benny says:

    Many people wonder if there is a natural cure for hiv or are looking for ways on how to get rid of hiv for good. there are many natural hiv remedies that can put Hiv into remission. there is a method for how to get rid of Hiv Wish is taking of herbal medicines. My problem with Hiv has caused me many traumas,especially in my sex life.I was so afraid of infectihng my boyfriend, I suffered the embarrassment of visiting dermatologists queries undreds of times. fUnfortunately,they did not find a definitive solution to my The solution camerom the least expected herbal doctor which is Dr smart. By reaproblem.ding in a specialised forum on the subject,How to cure Hiv virus completely. Many people had tried, with excellent and quick results.I had nothing to lose so I decided to contact dr.smart and use his herbal medicine to eliminate my Hiv. I spent two weeks using his herbal medicine and today my Hiv completely disappeared and turn out negative after numerous test from different hospital. I recommend this method to all people who want to eliminate the Hiv from their body forever, The doctor contact, dr.smartherbalcure@gmail.com or Call :+234901229596.He cure the bellow sickness/illness HERPES HSV 1 & HSV 2 ASTHMA DIABETES EPILEPSY CANCER INFERTILITY STAPHYLOCOCCUS. BARENESS HIV /AIDS HEPATITIS B Kidney? HPV ALS

  3. maria says:

    Hello everyone!! I was diagnosed of Genital Herpes Simplex Virus (HSV) in 2017 and I have tried all possible means to get cured, i even visited Some Hospital where they gave me some drugs like Famvir, Zovirax and Valtrex which are very expensive but all to no avail, until i saw a post in a health forum about a herbal doctor from West Africa who prepare herbal medicine to cure all kind of diseases including Herpes Simplex Virus, at first i doubted if it was real but decided to give it a try, when i contact this herbal doctor via his email he sent me a herbal medicine through courier service, when i received this herbal medicine, he gave me step by instructions on how to apply it, when i applied it as instructed i was totally cured of this deadly disease within 12-14 days of usage, if you are suffering of this diseases you can as well Contact this great herbal doctor via his email;
    dr.itamacuringhome@gmail.com. WhatsApp number +2348165485326

  4. brown says:

    Hello everyone!! I was diagnosed of Genital Herpes Simplex Virus (HSV) in 2017 and I have tried all possible means to get cured, i even visited Some Hospital where they gave me some drugs like Famvir, Zovirax and Valtrex which are very expensive but all to no avail, until i saw a post in a health forum about a herbal doctor from West Africa who prepare herbal medicine to cure all kind of diseases including Herpes Simplex Virus, at first i doubted if it was real but decided to give it a try, when i contact this herbal doctor via his email he sent me a herbal medicine through courier service, when i received this herbal medicine, he gave me step by instructions on how to apply it, when i applied it as instructed i was totally cured of this deadly disease within 12-14 days of usage, if you are suffering of this diseases you can as well Contact this great herbal doctor via his email;
    dr.itamacuringhome@gmail.com. WhatsApp number +2348165485326

  5. angela says:

    Hi Friends i am so glad to writing this article today to tell the world how Dr itama cured my HSV VIRUS,i have been detected with HSV-1 AND HSV-2 since five years ago, ever since then my life has been in complete bizarre and agony,i have used so many drugs that was prescribed to me by several doctors,but it didn’t cure my HSV VIRUS neither did it reduce the pain,until a certain i was checking for solution in the internet,then miraculously came across Dr itama the powerful herbalist that cure numerous individuals HSV-1 AND HSV-2 INFECTION,then i contacted his email: dr.itamacuringhome@gmail.com i explained everything to him and prepared a cure that cure my HSV-1 AND HSV-2 disease totally after receiving his herbal medicine, so my friends viewers why wait and be suffer when there is someone like Dr.itama that can cure any disease HIV/ CANCER/ HEPATITIS B VIRUS, you can contact hisvia:dr.itamacuringhome@gmail.com you call or whatsapp him number +2348165485326

  6. Bella David says:

    WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. I’m a citizen of USA, My younger sister was sicking of
    breast cancer and her name is David Sandra I and my family have taking her to all kind of hospital in USA still yet no good result. I decided to go to the internet and search for cancer cure so that was how I find a lady called peter Lizzy she was testifies to the world about the goodness of a
    herbal man who has the root and half to cure all kind of disease and the herbal man email was there. So I decided to contact the herbal man for my younger sister help tHe estado afectado por cáncer durante muchos años. Necesito curarme ahora.o cure her breast cancer. I contacted him and told him
    my problem he told me that I should not worry that my sister cancer will be cure, he told me that there is a medicine that he is going to give me that I will cook it and give it to my sister to drink for one week, so I ask how can I receive the cure that I am in USA, he told me That I will pay for the delivery service. The courier service can transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier service so I used it as the herbal man instructed me to, before the week complete my sister cancer was healed and it was like a dream to me not knowing that it was physical I and my family were very happy about the miracle of Doctor so my dad wanted to pay him 5 million us dollars the herbal man did not accept the offer from my dad, but I don’t know why he
    didn’t accept the offer, he only say that I should tell the world about him and his miracle he perform so am now here to tell the world about him if you or your relative is having any kind of disease that you can’t get from the hospital please contact joseph.healinghome@gmail.com or whatsapp him
    +2348024473237

  7. Hi my name is laural williams,here is my testimony on how i got cured from
    herpes by DR EDES.i caught genital herpes from my Ex Husband in 2015,he
    never told me about the virus. I had it for 2 years with so many outbreak,and it affected my
    life.. People think herpes is really a minor skin irritation herpes has a
    long term effects on health. The stigma attached to this virus by ignorant
    people is ridiculous. Most people have herpes in one form or another,i was
    first taking Antiviral medicines, such as acyclovir(Zovirax), famciclovir
    (Famvir), and valacyclovir (Valtrex), are recommended for treating primary
    genital herpes outbreaks. This medicine can be taken when an outbreak
    occurs. It can also be taken every day to help prevent outbreaks,it is not
    a total cure… I will like to tell everyone who is reading this my
    testimony on how i get rid of my genital herpes.I was reading a comment on
    the internet,and i saw a testimony posted by a young lady from USA that she
    got rid of her herpes with the help of doctor EDES,a Traditional
    Herbalist.So i was so happy when i saw that post,that his herbal medication
    Cure the virus totally.I quickly copied the herbal doctor email address and
    i email him within 30 minutes he respond to my mail.I explain things to him
    he told me not to worry that i should fill his herbal form which i did..The
    next day he told me that he has prepare the herbal medicine,that i should
    send him my address that he want to sent his HERBAL MEDICINE to me via DHL
    or FedEx that was how i got the herbal medication and i use it as i was
    instructed.After a week i went to see a Medical Doctor who confirmed my
    herpes was no more.When some of my friend who has herpes saw me they were
    surprise and i also introduce them to the man and they are also cure from
    the same Genital herpes today.I also refer my cousin to the same herbalist
    who was having HIV and today she is fully cure…If you have Genital or
    Oral herpes or any kind of Diseases and infections,kindly contact HERBALIST
    EDES via this email;dredeshome@gmail.com
    He also have a herbal cure for Following DISEASES,this is not scam is 100%
    Real.
    -PENIS ENLARGEMENT AND WEAK ERECTION
    -VIRGINA PROBLEM
    -WHOOPING COUGH
    – HEPATITIS B
    -FORDYCE SPOT
    -ALS
    -LOWER RESPIRATORY INFECTION
    -LOW SPERM COUNT
    -MRSA(METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS
    -ZIKA VIRUS
    -COPD
    -STROKE
    -IMPOTENCE
    -PILE
    -HYPERTENSION
    -LOW SPERM COUNT
    -MENOPAUSE DISEASE
    -ASTHMA
    -CANCER
    -BARENESS/INFERTILITY
    -PCOS
    -SHINGLES
    -VIRAL HEPATITIS/HEPATITIS B
    -FIBROID
    -ASTHMA
    -SICKLE CELL
    -TINNITUS
    -BARENESS/INFERTILITY
    -DIARRHEA and so on…

    HE CAN ALSO HELP YOU CAST A SPELL like,
    *EX BACK
    *WIN LOTTERY
    *BREAKING SPELL OF BARENESS
    *JOB PROMOTION
    *LOVE SPELL and so many more.

    Contact him today and you will have a testimony,you can also contact for
    details on this email;lauralwilliams002@gmail.com.
    GOD IS TRULY GREAT..Click on the link of the Doctor that cure me of my
    GENITAL HERPES;
    WHATSAPP him with this number +2348151937428
    GOOD LUCK.

  8. Dr Edes says:

    HELLO ARE YOU A VICTIM OF HIV AIDS/ CANCER
    PATIENTS***
    my name is Dr. EDES ,i have been a doctor for 26years
    now,i believe when there is GOD,root,herbs, fore
    fathers,ancestors, there is no sickness in this world that can
    not be cured.if you were told that HIV or CANCER can not be
    cured, he or she is lying as far as you where born by a
    woman,i’ve cured many from this sickness both from abroad
    and Africa. if you are a victim of this disease, please don’t
    hide or keep it to yourself so that you will not die before your
    time. life is sweet when you have good health BE WARNED.
    Why suffering in silence when there is remedy to your
    diseases. I also specialize in curing the following disease:
    *HIV/Aids
    *Kidney failure
    *Diabetes
    *Hypertension
    *Stroke *Obesity
    *Infertility/ Impotency
    *Cancer
    *Skin Problem
    *Fibroid Tumor
    *Ulcer
    *Asthma
    *Weight Management
    *Weak ejaculation
    *Pile e.t.c
    I also do love charm, bring back your ex or bring back your
    husband or wife, medicine to boost your business. charm to
    get influence and power in anything you are doing, contact us
    at via DREDESHOME@GMAIL.COM
    OR YOU CAN CONTACT ME ON MY WHATSSAPP NUMBER +2348151937428

  9. I want to inform the public how i was cured of HERPES Simplex Virus by a
    Doctor called Dr.EDES. i visited different hospital but they gave me list
    of drugs like Famvir, Zovirax, and Valtrex which is very expensive to treat
    the symptoms and never cured me. I was browsing through the Internet
    searching for remedy on HERPES and i saw comment of people talking about
    how Doctor EDES cured them. I Was scared because i never believed in the
    Internet but i was convince to give him a try because i was having no hope
    of been cured of HERPES so i decided to contact him on his email, i
    searched his email on net and i saw a lot of people testifying about his
    goodness. when i contacted him he gave me hope and send a Herbal medicine to me that i took and it seriously worked for me, am a free person now without problem, my HERPES result came out negative. You can contact him on his Email: dredeshome@gmail.com call or whatsapp him +2348151937428. Email me; alexandersam002@gmail.com and get all your problem
    solved. He also cure the following;
    -PENIS ENLARGEMENT AND WEAK ERECTION
    -VIRGINA PROBLEM
    -WHOOPING COUGH
    – HEPATITIS B
    -FORDYCE SPOT
    -ALS
    -LOWER RESPIRATORY INFECTION
    -LOW SPERM COUNT
    -MRSA(METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS
    -ZIKA VIRUS
    -COPD
    -STROKE
    -IMPOTENCE
    -PILE
    -HYPERTENSION
    -LOW SPERM COUNT
    -MENOPAUSE DISEASE
    -ASTHMA
    -CANCER
    -BARENESS/INFERTILITY
    -PCOS
    -SHINGLES
    -VIRAL HEPATITIS/HEPATITIS B
    -FIBROID
    -ASTHMA
    -SICKLE CELL
    -TINNITUS
    -BARENESS/INFERTILITY
    -DIARRHEA and so on…GOODLUCK.

  10. angelina says:

    I have been suffering hardship from HIV/AIDS since 6years now, and i have 2 kids for my husband, and now we cannot proceed to have any other child again because of my disease. I have gone to several places to seek for help yet nobody could help, until i met a comment on the daily news paper that was commented by a lady named Britney on how this powerful herbal doctor helped her get cured of her disease (HIV-AIDS). Firstly i thought seeking help from an African doctor was a wrong idea, but i said to myself, will i continue to live with this disease all my life when i have heard that somebody like me was healed and saved from the same HIV/AIDS, I said its not my portion to remain in this my condition. so i contacted him through his Email address at (dr.akhiniemodion@gmail.com), so after i have mailed him, he responded to me after some hours after and he said to me that i should not be afraid, that he is a truthful and powerful doctor which i firstly claimed him to be because of what i read about him before i contacted him. So he promised me that i will be healed but there are some items needed to prepare the herbal medicine and obeyed all that he said because am the one in need of help not him. I did all by accepting his Words, Some weeks of taking his herbal medicine i notice some changes in my body system and i went for check up the day he asked me to go for check up to confirm if the sickness was still there or not, to my greatest surprise i could not find any sickness on my body. Firstly i was shocked, i mean it was like a joke to me and later i arise to be the happiest woman on earth after i have concluded my final test on the hospital by my doctor that i am now HIV- Negative. My papers for check are with me and now i am so happy and glad for his miraculous work over my life. With these i must tell everyone who might seek for any help, either for HIV cure or much more to contact him now on his private Email: dr.akhiniemodion@gmail.com OR WHATSAPP HIM +2349033126596 He has done mine, he can also do yours.I will never forget the the happiness you brought back into my life.

    He cure listed diseases
    CANCER
    HIV
    ALS
    HEPATITIS A AND B
    DIABETIC.
    HERPES

  11. standard emirate says:

    Hello everyone!! I was diagnosed of Genital Herpes Simplex Virus (HSV) in 2015 and I have tried all possible means to get cured, i even visited Some Hospital where they gave me some drugs like Famvir, Zovirax and Valtrex which are very expensive but all to no avail, until i saw a post in a health forum about a herbal doctor from West Africa who prepare herbal medicine to cure all kind of diseases including Herpes Simplex Virus, at first i doubted if it was real but decided to give it a try, when i contact this herbal doctor via his email he sent me a herbal medicine through courier service, when i received this herbal medicine, he gave me step by instructions on how to apply it, when i applied it as instructed i was totally cured of this deadly disease within 21 days of usage, if you are suffering of this diseases you can as well Contact this great herbal doctor via his email; droduntunherbalhomecure@gmail.com or whatsapp him +2349039463501. thanks to doctor agbada oduntun i will forever be greatfull

  12. Flora Angelo says:

    I am here to appreciate Dr.Isai for using his herbal medicine to cure me from Herpes virus. For 4 years now I have been living with this virus and it has been giving me challenges, I was so perplexed cause i have been taking several drugs to be cured but all of my effort was in vain. One morning i was browsing through the internet then i saw several testimonies about Dr. Isai curing people from Herpes virus and other kinds of disease so immediately i contacted him on his email: drisaiherbalcenter@gmail.com and explain my troubles to him then he assured me that he will cure me, he gave me some instructions which i followed. Then he prepared a herbal medicine and sent it to me which i used for 2 weeks and everything was like a dream to me when i discovered that the Herpes virus was totally gone, I hereby recommend Dr.Isai to everyone suffering from herpes or any kind of disease he has a cure to them all. Also he is a very good and honest Doctor. contact him with this email address: drisaiherbalcenter@gmail.com or you whatsapp him on +2349034352176.

  13. donna albert says:

    Am Donna Albert by name, i was diagnosed with Herpes for 2years ago i lived in pain with the knowledge that i wasn’t going to ever be well again i contacted so many herbal doctors on this issue and wasted a large sum of money but my condition never got better i was determined to get my life back so one day i saw miss cassandra post on how Dr Osalu saved him from the VIRUS with his herbal medicine i contacted Dr Osalu on his email address drosaluherbalhome@gmail.com we spoke on the issue i told him all that i went through and he told me not to worry that everything will be fine again so he prepared the medicine and send it to me through courier service and told me how to use it,after 14days of usage I went to see the doctor for test ,then the result was negative,am the happiest woman on earth now. this testimony is real.thanks to Dr Osalu God bless you. you can also reach him on his email address drosaluherbalhome@gmail.com or whatsApp number +2348078668950.