The management of chronic pain in HIV by traditional complementary alternative medicine practitioners : guidelines for treatment and management

Background Chronic pain is a common clinical complaint and comorbidity that negatively affects the health-related quality of life of people with HIV across the world. The prevalence of chronic pain in HIV is high, with estimates that range from 25% to 85% of people. Chronic pain (CP) in HIV often results in impaired physical ability, a sequelae of clinical complaints and associated mental health problems. People with CP in HIV commonly seek alternative therapy parallel to their conventional therapy, such as opioid analgesics, to manage their pain. One such therapy is traditional complementary alternative medicine therapies (TCAM). Although widely utilised for CP in HIV, TCAM healthcare practices are understudied due to the limited knowledge of the efficacy and safety of these therapies in this field of healthcare. Aim The aim of this study was to explore the treatment and management practices for chronic pain in HIV by selected traditional alternative medicine therapies practitioners and to develop TCAM practitioner guidelines for CP management in HIV. Methodology A qualitative, explorative, descriptive contextual design, within an interpretivist paradigm, was employed to guide this study. Data were collected from 13 traditional complementary alternative medicine practitioners in the eThekwini Municipality, KwaZulu-Natal, South Africa, utilising purposive and snowball sampling strategies, respectively. These TCAM practitioners consisted of chiropractors, homeopaths, and traditional health practitioners. Semi-structured, face-to-face interviews were employed to collect data. Data were transcribed verbatim and analysed using Tesch’s eight steps of thematic analysis. Findings It emerged that TCAM practitioners are actively treating and managing chronic pain in HIV, through their various disciplines. The THPs prescribed various traditional herbs either orally or topically. The THPs also relied on ancestral intervention for treating chronic pain in HIV. The chiropractors utilised various manual techniques in their management of chronic pain, whilst the homeopaths made use of remedies, herbs, minerals and vitamins in their treatment protocols. Although referrals amongst and between the TCAM practitioners were common there were no active referral patterns between mainstream healthcare professionals and TCAM practitioners for chronic pain in HIV, which emerged as a barrier in the care for HIV patients suffering with chronic pain.