BACKGROUND: People with HIV (PWH) are at a disproportionate risk for experiencing both chronic pain and opioid use disorder (OUD). Prescription opioid tapering is typically addressed within the "silo model" of medical care, whereby attention is focused solely on opioid addiction rather than also addressing chronic pain management, and limited communication occurs between patient and providers. OBJECTIVE: This descriptive case study examined an integrative, collaborative care model consisting of Provider, Physical Therapist (PT), and Patient aimed at decreasing chronic pain and opioid use within a multidisciplinary HIV/AIDS clinic. METHOD: A physical-therapy based model of chronic pain mitigation and physician-driven opioid tapering was implemented. The Provider, PT, and Patient worked collaboratively to address physiological pain, pain coping skills and opioid tapering. A patient case example was used to illustrate the implementation of the model for a future, larger study in the same patient population. RESULTS: This model was feasible in this case example in terms of clinic workflow and acceptability to both the Patient and Providers in this clinic. After the intervention, the Patient's pain was fully eliminated, and he had ceased all opioid use. CONCLUSION: Results of this case study suggest that utilizing an integrative, patient-centered approach to both chronic pain management and opioid tapering may be feasible within the context of a multidisciplinary HIV/AIDS clinic. Generalizability is limited by case study model; however, this gives insight into the value of a collaborative alternative compared to a "silo" model of opioid tapering and chronic pain management in preparation for a larger study.

Chronic pain–widely classified as pain lasting longer than 3 months–has emerged as a treatment priority among people living with HIV (PLHIV), and has been associated with decreased patient retention in HIV primary care. This retrospective cohort study evaluated the changes in self-reported pain scores and analgesic usage for HIV-positive adults with chronic pain enrolled at a large, urban HIV clinic in Atlanta, Georgia, USA who received a physical therapy (PT) intervention compared with a demographically matched cohort who did not receive PT. Retrospective data was collected from patients’ charts who received PT, and from patients’ charts who did not receive PT during the time period. Patients who had received PT were referred by their primary HIV providers at the clinic, but were not recruited specifically for study purposes. Results revealed that among patients who received PT interventions, the majority (93.5%) reported a decrease or total elimination of pain. In addition, all of the patients who received PT reported decreased analgesic use, with the exception of opioids, which remained unchanged. Among patients who did not receive PT intervention, there was an overall increase in analgesic usage in all medication categories including opioids. The majority of the non-PT group (74%) reported increased or unchanged pain over the study period. In a non-randomized sample of HIV-positive adults at one HIV clinic, PT intervention appears to be an effective, non-pharmacological method to decrease chronic pain and analgesic use in selected persons living with HIV.

Chronic pain management has become a treatment priority for people living with HIV (PLH), and PLH may be at increased risk for opioid addiction. Physical therapy (PT) has been shown to be effective as a nonpharmacological method of chronic pain management; however, there is a gap in research examining the role of PT for chronic pain, especially as it relates to opioid reduction, in this patient population. This retrospective study evaluated pain level and opioid use before and after PT intervention among HIV-positive adults with chronic pain on chronic opioid therapy (n = 22). The study was conducted at a multidisciplinary AIDS clinic in Atlanta, GA. Outcome measures were self-reported pain on the numerical rating scale (0-10) and morphine milligram equivalents (MMEs), which measure opioid use. A majority of patients (77%) demonstrated a decrease in pain by the conclusion of the study period; however, only 18.2% of patients reported decreased pain as well as a decrease in MMEs. The most common PT treatments used among the patients with a decrease in pain and/or opioid use included home exercise programs, manual therapy, and self-pain management education. Eighty percent of the participants who did not decrease opioid use reported a decrease or elimination of pain by the end of the PT intervention. This reflects the need for careful consideration of the complexity of opioid use and addiction, and the importance of a multidisciplinary team to best serve the needs of PLH aiming to decrease chronic pain and opioid use.

This clinical conversation discusses the importance of a wholistic approach to HIV/AIDS care, with physical therapy as a critical part of the care team.

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No abstract available.

Background: HIV-related chronic pain has emerged as a major symptom burden among people living with HIV (PLHIV). Physical therapy (PT) has been shown to be effective as a non-pharmacological method of chronic pain management in the general population; however, there is a gap in research examining the role of PT for chronic pain among PLHIV. Materials and methods: This study examined the effect of PT on self-reported pain scores and pain medication usage in PLHIV enrolled in a multidisciplinary HIV clinic. Data were collected via reviews of patient medical records within a certain timeframe. Data were gathered from patient charts for two points: initial PT encounter (Time 1) and PT discharge or visit ≤4 months after initial visit (Time 2). Results: Subjects who received PT during this timeframe reported decreased pain (65.2%), elimination of pain (28.3%), no change in pain (15.2%), and increased pain (6.5%). Threequarters of the subjects reported a minimal clinically important difference (MCID) in pain score, and more than half reported a decrease in pain score over the MCID. Subjects showed a trend of decreasing pain medication prescription and usage during the study period. Conclusion: Results of the current study indicate that in this sample, PT intervention appears to be an effective, cost-effective, non-pharmacological method to decrease chronic pain in PLHIV.

Introduction: The vast progress in management of HIV disease with anti-retroviral therapy (ART) in the past three decades has resulted in increased life expectancy for people living with HIV/AIDS. With this new chronicity of the disease has emerged a constellation of musculoskeletal impairments ranging from arthritis to traumatic fractures requiring orthopedic surgery. This manuscript aims to review and critique recent research (2009-2014) investigating musculoskeletal complications of HIV disease, and to propose future directions for management of such diagnoses. Methods: The literature reviewed was divided into the following categories, in order of publication date: general musculoskeletal complications arising from the HIV virus itself and/or ART, HIV-related bone infections and bone disease, rheumatic disease in HIV infection, vitamin D deficiency in HIV disease, and orthopedic post-surgical complications/risk factors resulting from HIV disease. Results: A total of 19 articles met the described inclusion criteria and were included in this critical review. From most recent (2014) to oldest (2009), 4 articles were published in 2014, 7 in 2013, 3 in 2012, 1 in 2011, 2 in 2010 and 2 in 2009. Discussion: While the pathophysiology of HIV-related musculoskeletal complications is well documented in the literature, it is crucial that attention is also focused on treatment. The complex nature of disability in PLWHA necessitates a multidisciplinary approach to treatment to adequately address the diagnostic and treatment needs of this population. Conclusion: Given the multitude of musculoskeletal complications that arise from the HIV virus and/or ART, research must be continuously conducted to assess risk, prevention and treatment. This research will need to focus on both non-surgical and surgical approaches to management of musculoskeletal complications in the HIV-infected individual.

Background: The advent of highly active antiretroviral therapy has dramatically extended the life expectancy of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Despite this increased longevity, HIV disease and its pharmacological treatment can cause long-term and acute health complications, many of which can be treated successfully by physiotherapy. The purpose of this paper is to report the effect of a 12-week rehabilitation program on several health-related markers in a 43-year-old woman living with HIV. Methods: This case study examined the effect of a 12-week exercise and manual therapy intervention on morphology, pain, cardiopulmonary fitness, strength, neurological balance, immune markers (CD4 cell count), and quality of life in a 43-year-old woman living with HIV. Results: The results showed complete elimination of pain and shortness of breath on exertion. There was also a reduction in resting heart rate, waist circumference, exercise duration, muscle strength, and endurance. The patient showed an increase in peak expiratory flow rate, maximal heart rate attained, upper arm, forearm, and thigh circumference, and CD4+ cell count. The patient also showed improvements in the quality of life domains of general health, pain, energy/fatigue, social and physical functioning, and emotional well-being. Conclusion: Physiotherapy interventions consisting of exercise and manual therapy appear beneficial in several areas as an adjunct therapy in HIV management.

Background and Purpose: The increasing complexity of medical care in the United States calls for providers to become leaders in various aspects of health care. Combining clinical skills with knowledge of public health and the business/administrative side of health care allows health care providers, including physical therapists, to effectively manage and navigate the changing health care environment and become leaders in their field. The purpose of this paper is to describe the method and process of successfully establishing dual degree programs in business and public health and in the physical therapist education program at Emory University. Method/Model Description and Evaluation: The process for institutional level agreements, curricular structure, admissions process, and graduation requirements for dual degree program students in the Doctor of Physical Therapy (DPT) and Master of Business Administration (MBA) or Master of Public Health (MPH) at Emory University is described in this paper. Additionally, 2 surveys were conducted: 1 survey of all students in 3 DPT classes (n = 201) and the other survey of dual degree program graduates as of 2013 (n = 8). The surveys evaluated student awareness of the dual degree programs during the DPT program application process and characteristics and perceptions related to the dual degree programs. Outcomes: Eighty-three percent of all students indicted that they were aware of the dual degree programs while applying to our DPT program and 6% indicated it was a key deciding factor in their decision to apply to our program. The graduating grade-point average (GPA) and first time pass rate on the National Physical Therapy Exam (NPTE) licensure of the dual degree students in the DPT program is at least equal to that of the overall DPT class graduating the same year. Moreover, 86% of dual degree program graduates indicated that it made them a more competitive job candidate. Discussion and Conclusion: In addition to fostering interprofessional education, the dual degree programs at Emory show positive outcomes, as all graduates indicated that their dual degree positively impacted their careers, and the majority reported specifically using their dual degree in their career. Also, the graduating GPA and first time pass rate on the NPTE of the dual degree students in the DPT program is at least equal to that of the overall DPT class graduating the same year, suggesting that the burden of an additional course of study was not adversely impacting their performance in the DPT program. At Emory University, the dual DPT/MBA and DPT/MPH programs have been designed to provide students with the necessary clinical, business, administrative, policy analysis, and public health perspectives required to excel as leaders in the future health care system.