Are Back Pain and HIV Connected?

Curated by Claudia Shannon / Research Scientist / ishonest

Why do people with HIV experience back pain?

In the 2017 study mentioned earlier, researchers found that people with HIV most commonly reported the following types of pain:

  • headaches: 17.9 percent
  • abdominal pain: 15.6 percent
  • backaches: 13.3 percent

Researchers also found that women were 1.8 times more likely to experience pain than men in this study.

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The HIV virus and antiretroviral drugs are both thought to contribute to chronic pain. However, it may be difficult to pinpoint the cause of pain based on symptoms alone.

If your symptoms begin shortly after starting drug therapy, your doctor may suspect that the medication — and not the virus — are the cause of your back pain.

Next, we’ll discuss some of the other causes of chronic pain in people with HIV.

Peripheral hypersensitivity

It’s thought pain receptors in people with HIV often become hypersensitized to inflammation.

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If you’re dealing with a condition that causes inflammation in your back, like an injury or rheumatoid arthritis, the pain may be magnified due to changes to your immune system in response to the virus.

Hypersensitization to inflammation may cause pain even after the inflammation has passed.

In a 2014 study, researchers examined the MRI results of 22 people with HIV who were experiencing chronic back pain. The three most common conditions people were dealing with were:

  • degenerative disc disease (14 people)
  • nerve impingement (5 people)
  • renal cysts (3 people)

Some participants had more than one condition.

Peripheral neuropathy
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Antiretroviral drugs and HIV may also lead to back pain by causing peripheral neuropathy. Peripheral neuropathy is damage to a nerve outside of your brain or spinal cord.

Along with pain, neuropathy can cause symptoms such as:

  • weakness
  • tingling
  • numbness
Central sensitization

Another cause of back pain in people with HIV is central sensitization. Central sensitization is when your brain receives a pain signal despite there being no injury or inflammation.

What are the different types of back pain you might have with HIV?

Back pain in people with HIV can vary significantly between people.

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The pain can range from mild to severe and can manifest as tightness, throbbing, pressure, or sharp pain. People with neuropathies often describe the pain as burning, tingling, or stabbing.

While you can have pain in any part of your back, many people experience it in their lower spine.

If you have a particular back issue, your pain may be amplified due to changes to your immune system.

Your exact symptoms will depend on the underlying cause of pain. For example, if you have degenerative disc disease in your lower back, your pain may:

  • primarily affect your lower back
  • extend to your legs or buttocks
  • worsen after twisting or sitting
  • come and go over days to months

Can you prevent back pain?

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The first step to relieving back pain when dealing with HIV is to work with your doctor to develop a treatment plan.

Your doctor can help you keep HIV from progressing and adjust your medications if they suspect one of them is contributing to your pain.

You can also help prevent back pain by taking care of your spinal health to prevent degenerative disease and injuries. Some steps you can take include:

  • doing back strengthening and stretching exercises twice per week
  • standing and sitting with good posture
  • avoid heavy lifting; when you do lift heavy objects, bend your knees and keep your back straight
  • stay active and eat a nutrient-dense diet

How is back pain treated when you have HIV?

You can talk with a healthcare professional to decide the best treatment option to help you deal with back pain.

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A number of non-medication–based treatments may help reduce back pain, including:

  • acupuncture or acupressure
  • cold and heat therapy
  • hypnosis
  • massage
  • meditation
  • mental imagery
  • physical activity
  • physical therapy

For mild to moderate pain, your doctor may recommend acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), or steroids.

For moderate to severe pain, your doctor may prescribe opioids such as:

  • codeine
  • hydrocodone (Vicodin)
  • morphine
  • oxycodone (OxyContin)

It’s important to note that the use of opioids can potentially to lead to substance misuse which can then lead to addiction. So when prescribed, your doctor will carefully monitor your use of these medications.

What’s the outlook for people with back pain and HIV?

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Pain caused by HIV is often treatable if you work with your doctor. But the outlook of your pain depends on many factors, such as:

  • underlying cause of your pain
  • severity of your pain
  • how far along the HIV infection has progressed

If your medications are contributing to your pain, changing them may help relieve discomfort. However, you shouldn’t stop taking any of your medications without first consulting your doctor.

The bottom line

People with HIV often experience chronic back pain and pain in other parts of their bodies such as their abdomen, head, and joints. A number of factors can contribute to this chronic pain.

HIV and antiretroviral drugs may lead to changes in your immune system that make your pain receptors hypersensitive.

They can also cause nerve damage or cause your brain to interpret pain even without inflammation or tissue damage.

If you’re dealing with chronic back pain and you have HIV, it’s a good idea to talk with your doctor about potential treatment options.

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