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Chronic Pain Mitigation and Opioid Weaning at a Multidisciplinary AIDS Clinic

A Case Report

Pullen, Sara, DPT, MPH, CHES

doi: 10.1097/01.REO.0000000000000159
CASE REPORT
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Background and Purpose: Chronic pain has emerged as a treatment priority among people living with HIV (PLHIV). Recent studies indicate the use of physical therapy (PT) for chronic pain mitigation among PLHIV; however, there is a paucity of literature regarding PT as part of multidisciplinary collaboration to address the intersection of HIV, chronic pain, and opioid use.

Case Description: This case report examined the effect of a 24-session PT intervention aimed at decreasing chronic pain and opioid weaning for a 64-year-old patient at a multidisciplinary AIDS clinic in Atlanta, Georgia. The PT intervention focused on pain mitigation, using pain relief techniques such as a home TENS (transcutaneous electrical nerve stimulation) unit, home stretching regimen, and diaphragmatic breathing techniques. In addition, the physical therapist communicated regularly with the patient's primary HIV provider regarding patient progress.

Outcomes: After the intervention, outcomes included decreased pain from 10/10 to 0/10, independent pain management, and increased independence in functional activities. In addition, the patient decreased opioid usage from 15 to 2.5 mg hydrocodone, an 83.3% decrease.

Discussion: In a complex chronic pain case with a patient on chronic opioid therapy, multidisciplinary communication is key in successful management. To truly address opiate weaning in the context of pain management, physical therapists' expertise in pain management should ideally be complemented by close communication with the patient's primary medical provider. This allows for open dialogue and acknowledges the importance of various specialty areas committed to a joint effort not of simply opioid weaning but of patient-centered, multidisciplinary chronic pain control.

Associate Professor, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA

Correspondence: Sara Pullen, DPT, MPH, CHES, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1462 Clifton Rd, NE, Atlanta, GA 30322 (sara.pullen@emory.edu).

Grant Support: Dr Pullen has a grant (P30AI050409) for support of this research, from the National Institutes of Health, Center for AIDS Research at Emory University.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.rehabonc.com).

The author declares no conflicts of interest.

Copyright 2019 © Academy of Oncology Physical Therapy, APTA
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