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Pain Management and Chemical Dependency Index
| 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:
In addition, rheumatologic pain develops in 30% and soft tissue damage accounts for about 60% of the reported somatic and visceral pains. |
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| 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:
Also, both study groups did not differ significantly in pain intensity, pain relief, or functional impairment.
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For professional correspondence, please contact Dr. Breitbart at: breitbart@neuro.mskcc.org
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
Conrad Notes IndexPain Management And Chemical Dependency Index
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