Neuropathic Pain in AIDS Patients Prior to Antiretroviral Therapy (Original Articles) (Acquired Immune Deficiency Syndrome) (Report‪)‬

The human immunodeficiency virus (HIV) has a predilection for nerve tissue; therefore, the peripheral nerves, spinal cord and brain are frequently affected in patients with HIV/AIDS, resulting in a high prevalence of neuropathic pain. Neuropathic pain is defined by the International Association for the Study of Pain (IASP) as '... pain initiated or caused by a primary lesion or dysfunction of the nervous system'. (1) The lesion may occur anywhere within the central or peripheral nervous system and may lead to structural and functional changes in the nervous system, resulting in altered central neural processing of sensory input (central sensitisation). Consequently, pain may persist long after healing of the original injury. Neuropathic pain may therefore be regarded as abnormal activation of pain pathways. Neuropathic pain syndromes typically present with both negative and positive sensory symptoms and signs. The usual qualities of neuropathic pain are burning, pricking, shooting or aching. This may be accompanied by hyperalgesia, allodynia, dysaesthesia or paraesthesiae. Neuropathic pain is not necessarily an all-or-nothing phenomenon but may be part of a spectrum where the pain is 'more or less neuropathic' in origin, hence the concept of pain of predominantly neuropathic origin (POPNO). (2,3)