Guide to HIV Associated Musculoskeletal Pain Treated with Massage by Osteopaths

What Musculoskeletal and Rheumatological Conditions Occur in HIV Patients?

The high prevalence of musculoskeletal involvement  of HIV cases occurs in the advanced stages. Though stage 2 patients predominantly suffer from arthralgia, spondyloarthropathy, and rheumatoid arthritis. Whereas patients with stage 3 disease had suffer predominantly from body ache and mechanical low back pain, but patients with stage 4 disease had suffered predominantly from septic arthritis, osteomyelitis, and pyomyositis (Kole et al. 2013).

However, musculoskeletal disorders are not always related to the HIV infection, these may be either the direct effect of the virus, opportunistic infections, noninfectious HIV complications (malignancy, drug toxicities), or unrelated rheumatologic disorders whose course have been altered (Kole et al. 2013).

How Might Musculoskeletal Pain Manifest In HIV Patients?

Myalgia (muscle pain) was the commonest symptom present and arthralgia(joint pain) involving knee, shoulder, and elbow are frequent complaints. The most distressing musculoskeletal disorders were mechanical low back pain and painful articular syndromes (Kole et al. 2013).

How Might Massage Help HIV Patients?

Musculoskeletal involvement in human immunodeficiency virus infected patients are important disease manifestations, responsible for increased morbidity and also decreased quality of life (Kole et al. 2013).
The effects of massage on HIV / AIDS musculoskeletal soft tissues include pain relief, decreased levelof depression, improved immune function, improved blood floand blood composition, reduced edema, and increased mobility of connective tissue, muscle and the nervous system . Massage is therefore potentially effective in improving the quality of life in patients suffering from chronic disorders (Hillier et al. 2010).
Furthermore, an increase in immune function following massage where the proposed mechanisms for this effect occurs via alterations in bio-chemistry, such as reduced levels of cortisol and increased levelof serotonin and dopamine. Though what mediates these biochemical effects is not known but presumed to occur through stress reduction (Hillier et al. 2010).

Effectiveness of Massage for HIV Musculoskeletal Pain

In a Cochrane review by Hillier et al. (2010),  they found that individuadomains of quality of life, there were findings in favour of massage therapy in combination with other modalities,such as meditation and stress reduction, being superior to massage therapy alone oto the other modalities alone.

The Suitability of Massage for Musculoskeletal Pain in HIV Patients?

Osteopaths have had success at managing  musculoskeletal complaints in HIV patients at the Blanchard Clinic (affiliated with the University College of Osteopathy, London). There is even research to suggest massage treatment might be effective for managing the musculoskeletal pain associated with HIV.
Though bear in mind, the osteopath will decide whether massage isa suitable and safe treatment option for managing musculoskeletal pain associated with HIV by completing an appropriate case history and examination or decide to refer you to the most appropriate medical practitioner.

The Challenge of Managing HIV Patients in Musculoskeletal Practice

The major challenges for the osteopath includes not only recognizing HIV infection associated rheumatic disorders but also distinguishing them from classic rheumatic diseases like rheumatoid arthritis, SLE, spondyloarthropathy, and vasculitis. So an aggressive multidisciplinary approach to early detection and timely intervention of these disorders, sometimes in consultation with a rheumatologist are all essential for effective management and to improve the quality of life (Kole et al. 2013). The other consideration is infection control during treatment.

HIV Infection Control During Treatment

As a blood-borne pathogen HIV is controllable in healthcare environments using the same guidelines and universal precautions which prevent all blood-borne infections including infectious hepatitis. The routine practice of osteopathy involves non-invasive manual contact only, therefore precautions are minimal. On the occasions that digital work within body cavities does take place (i.e. intraoral, peranal) the practitioners hand should be suitably gloved (Blanchard, 2009).

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Reference List

Blanchard PD (2009).  Masterclass: HIV-infection and osteopathy. International Journal of Osteopathic Medicine 12: 115–120
Hillier SLLouw QMorris LUwimana JStatham S (2010). Massage Therapy for People with HIV/AIDS.  Cochrane Database Syst Rev. Jan 20;(1):CD007502
Kole AK, Roy R, Kole DC (2013)Musculoskeletal and rheumatological disorders in HIV infection: Experience in a tertiary referral center. Indian J Sex Transm Dis. 2013 Jul;34(2):107-12.

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