Ageing International

, Volume 44, Issue 1, pp 74–116 | Cite as

A Biopsychosocial Approach to Managing HIV-Related Pain and Associated Substance Abuse in Older Adults: a Review

  • Theodore R. MillerEmail author
  • Perry N. Halkitis
  • Ramani Durvasula


The advent and uptake of effective antiviral therapies has transformed HIV/AIDS into a chronic manageable illness. The majority of Americans living with HIV are now ages 50 and older. Given the confluence of aging and HIV, chronic pain among older persons living with HIV/AIDS (PLWHA) has emerged as an area of clinical importance. Treatment of pain among this population is complex due to the prevalence of substance abuse and psychiatric illness in the population as well as the challenges of disentangling how inflammation associated with aging and HIV interact to predispose pain. Through a review of the extant literature we examine the complex associations between substance use, mental health, psychosocial issues, and chronic pain using a biopsychosocial framework in order to provide a means of addressing the aging-chronic pain link in older PLWHA. Using this frame, we then consider treatment implications for the population.


Chronic pain Pain Pain management HIV AIDS Pain assessment Biopsychosocial Ageing Substance abuse Psychiatric illness HIV-neuropathy Neuropathy HIV-sensory neuropathy 



The authors gratefully acknowledge the contributions of Dr. Linda Honan, Professor of Nursing, Yale University, for her expert guidance and review of the final stages of this work.

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest.

Informed Consent

Obtained from all individual participants of studies included for this research. For this type of study formal consent is not required.

Ethical Treatment of Experimental Subjects (Animal and Human)

This article does not contain any studies with human participants or animals performed by any of the authors.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Primary Care Division, Yale School of NursingYale University West CampusWest HavenUSA
  2. 2.Department of BiostatisticsSchool of Public Health, Rutgers UniversityPiscatawayUSA
  3. 3.Departments of Urban-Global Public Health, School of Public HealthRutgers UniversityNewarkUSA
  4. 4.Center for Health, Identity, Behavior & Prevention Studies, School of Public HealthRutgers UniversityNewarkUSA
  5. 5.Department of PsychologyCalifornia State UniversityLos AngelesUSA
  6. 6.Department of Educational PsychologyUniversity of JohannesburgJohannesburgSouth Africa

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