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      Chronic pain in people with HIV: a common comorbidity and threat to quality of life


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          Evidence indicates that over half of all people with HIV (PWH) will experience nonmalignant chronic pain throughout their lifetimes, with increasing prevalence as they age. Peripheral neuropathy resulting from the neurotoxic effects of HIV itself and the medications used to treat HIV were widely considered the primary cause of acute and chronic pain early on in the antiretroviral treatment era. However, recent studies suggest a predominance of non-neuropathic (e.g., musculoskeletal) pain in PWH with uncertain etiology. Chronic pain is often widespread in PWH, affecting multiple body locations. Additional research is needed to better understand contributors to chronic pain in PWH, which is likely to include biological (e.g., immune dysregulation), psychological (e.g., substance abuse) and social (e.g., stigma) factors.

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          Pain regulation by non-neuronal cells and inflammation

          Acute pain is protective and a cardinal feature of inflammation. Chronic pain after arthritis, nerve injury, cancer, and chemotherapy is associated with chronic neuroinflammation, a local inflammation in the peripheral or central nervous system. Accumulating evidence suggests that non-neuronal cells such as immune cells, glial cells, keratinocytes, cancer cells, and stem cells play active roles in the pathogenesis and resolution of pain. We review how non-neuronal cells interact with nociceptive neurons by secreting neuroactive signaling molecules that modulate pain. Recent studies also suggest that bacterial infections regulate pain through direct actions on sensory neurons, and specific receptors are present in nociceptors to detect danger signals from infections. We also discuss new therapeutic strategies to control neuroinflammation for the prevention and treatment of chronic pain.
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            HIV infection: epidemiology, pathogenesis, treatment, and prevention.

            HIV prevalence is increasing worldwide because people on antiretroviral therapy are living longer, although new infections decreased from 3.3 million in 2002, to 2.3 million in 2012. Global AIDS-related deaths peaked at 2.3 million in 2005, and decreased to 1.6 million by 2012. An estimated 9.7 million people in low-income and middle-income countries had started antiretroviral therapy by 2012. New insights into the mechanisms of latent infection and the importance of reservoirs of infection might eventually lead to a cure. The role of immune activation in the pathogenesis of non-AIDS clinical events (major causes of morbidity and mortality in people on antiretroviral therapy) is receiving increased recognition. Breakthroughs in the prevention of HIV important to public health include male medical circumcision, antiretrovirals to prevent mother-to-child transmission, antiretroviral therapy in people with HIV to prevent transmission, and antiretrovirals for pre-exposure prophylaxis. Research into other prevention interventions, notably vaccines and vaginal microbicides, is in progress. Copyright © 2014 Elsevier Ltd. All rights reserved.
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              Why rejection hurts: a common neural alarm system for physical and social pain.

              Numerous languages characterize 'social pain', the feelings resulting from social estrangement, with words typically reserved for describing physical pain ('broken heart', 'broken bones') and perhaps for good reason. It has been suggested that, in mammalian species, the social-attachment system borrowed the computations of the pain system to prevent the potentially harmful consequences of social separation. Mounting evidence from the animal lesion and human neuroimaging literatures suggests that physical and social pain overlap in their underlying neural circuitry and computational processes. We review evidence suggesting that the anterior cingulate cortex plays a key role in the physical-social pain overlap. We also suggest that the physical-social pain circuitry might share components of a broader neural alarm system.

                Author and article information

                Pain Manag
                Pain Manag
                Pain Management
                Future Medicine Ltd (London, UK )
                02 June 2020
                July 2020
                02 June 2020
                : 10
                : 4
                : 253-260
                [1 ]Department of Anaesthesia & Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
                [2 ]HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
                [3 ]Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
                Author notes
                [* ]Author for correspondence: Tel.: +1 205 934 6536; Fax: +1 205 975 6110; bgoodin1@ 123456uab.edu
                Author information
                © 2020 Burel R. Goodin

                This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License

                : 27 January 2020
                : 16 April 2020
                : 02 June 2020
                Page count
                Pages: 8
                Special Report

                access to care,biopsychosocial,hiv,inflammation,mental health,pain,prevalence,quality of life,social support,stigma


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