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Conrad Notes IndexspacerPain Management and Chemical Dependency Index

Conrad Notes
a timely medical meeting newsletter
PAIN MANAGEMENT IN HIV/AIDS
W. Breitbart, MD, Memorial Sloan Kettering Cancer Center (MSKCC), New York City, emphasized the similarities in managing cancer- and HIV/AIDS-related pain. Both types of patients experience a lower quality of life and functional performance because of under-treated pain. Clinicians often do not believe the pain level reported by intravenous drug users (IDU) although research data fail to support this impression.
HIV/AIDS Pain Pain-free HIV/AIDS patients present significantly less depression, overall psychological distress, hopelessness, and suicidal ideation. Pain problems occur in 30% to 60% of HIV/AIDS patients. Prevalence and pain intensity increase with disease progression. As in cancer pain, these patients average 2.5 to 3 pains at one time. Typically, HIV/AIDS patients report initial numbness, burning, and tingling of the hands and feet. This neuropathic pain spreads to involve the lower extremities; abdominal pain follows from opportunistic infection.

Breitbart further describes HIV/AIDS pain as:

  • directly related to HIV/AIDS virus: 40%

  • associated with therapy: 30%

  • unrelated to virus or treatment: 10%

In addition, rheumatologic pain develops in 30% and soft tissue damage accounts for about 60% of the reported somatic and visceral pains.

Study in women Breitbart's three-year evaluation showed HIV/AIDS pain under-treated in twice as many females as males. The pains were often pelvic or gynecologic. Females, compared with males, had significantly higher rates of radiculopathy, headache, and peripheral neuropathy.
Pain management In 114 ambulatory HIV/AIDS patients reporting severe pain, Breitbart found only 7/114 (6%) received a strong opioid such as morphine, hydromorphone, or fentanyl. Thirty of 114 (26%) received no analgesic. Other treatments included 41% nonste- roidal antiinflammatories, 24% weak opioids (codeine or codeine-containing), and 6% antidepressants or anticonvulsants.
IDU- vs nonIDU-reported pain Contrary to data collected by Breitbart, many clinicians view IDU as synonymous with exaggerated or fabricated pain:
IDU GroupNonIDU Group
No. of Patients 266 239
Reporting Pain 179 (67%) 142 (59%)
Ave. No. of Pains 2.5 2.5

Also, both study groups did not differ significantly in pain intensity, pain relief, or functional impairment.

For professional correspondence, please contact Dr. Breitbart at: breitbart@neuro.mskcc.org

Eugene A. Conrad

Presented at the Conference on Pain Management and Chemical Dependency on 22 Nov 1996
CONRAD NOTES © All Rights Reserved December 1996
Eugene A. Conrad, PhD, MPH / ISSN 1078 / posted on 1-Feb-1997

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