Pain therapy in HIV-associated polyneuropathy

Only some patients with HIV-infection receive an adaquate pain therapy. In later stages of HIV-infection up to 50 % of patients perform extraordinary doctor visits because of pain. Principally primary and secondary neuromanif estations of HIV-infection have to be differenciated. Rare forms of HIV-ass ociated polyneuropathies represent mononeuropathy or mononeuritis multiplex , acute and chronic inflammatory demyelinating polyneuropathy and polyneuro pathy caused by opportunistic infections. HIV-associated distal-symmetric p olyneuropathy represents the most common form during HIV-infection with a p revalence up to 50 %. Typical clinical symptoms and signs are pain, hyp- an d dysaesthesia, diminuted deep tendon reflexes, motor deficits and autonomi c disturbances. Always neurogical examination and neurophysiologic investig ation on the sural and peronaeal nerve are necessary for monotoring progres sion of polyneuropathy and as basics before starting antiretroviral therapy with neurotoxic substances. According to momentary opinion, HIV-associated distal-symmetric polyneuropathy represents no indication for antiretrovira l therapy. Symptomatic therapy includes antiepileptic medication as gabapen tine, antidepressiv drugs as amitriptyline and additionally retarded opiate s. Depressive disorders may accentuate pain problems and need psychotherape utic and thymoleptic therapy. Special problems occur when neurotoxic substa nces evoke or deteriorate polyneuropathy. In these cases an individual ther apeutic proceeding about continuation or discontination of neurotoxic medic ation is necessary. Symptoms of myopathy during HIV-infection are muscle pa in, elevation of CK and typical changes of motor units detedted by electrom yography. In most cases biopsy is necessary for diagnosis of specific forms of HIV-associated myopathy. HIV-associated polymyositis is treated by non- steroid analgetics, corticolds, immunoglobulines and plasmapheresis, myopat hy induced by neurotoxic medication analogous to polyneuropathy.