Pain in hospitalized HIV-positive patients: clinical and therapeutical issues

Abstract

Pain is frequently reported by patients infected with Acquired Immunodeficiency Virus (HIV), and its causes and specific treatment should be appropriately investigated. We evaluated 197 hospitalized HIV-positive patients with serial interviews and analysis of prescriptions and clinical evolution charts. The main characteristics of pain reported by these patients were: high intensity (60.7%), high frequency (72.0%) and well-known causes (88.8%). Fifty-two per cent of the patients reported persistent or frequent pain during the two weeks before hospital admission. Parameters such as gender, educational level and Karnofsky Index showed no direct relation to the presence or absence of pain. The most commonly affected sites were the head (28.0%) and the abdomen (26.2%). The frequency of indications of pain in the clinical evolution charts (46.2%) was considerably lower than the frequency of complaints reported by patients during the interviews (76.3%). Pain was undertreated in 83.2% of patients, both due to poor efficacy of the prescribed medications and to the excessive and inefficient use of standing order ("if necessary") regimens. We observed that pain was better managed during the hospitalization period, although this cannot be explained by improvement of the analgesic treatment; it might be due to successful treatment of the underlying disease. We concluded that pain reported by hospitalized HIV-positive patients is often underestimated and inadequately treated by assisting doctors, in spite of its severity and frequency.

Managing pain in HIV/AIDS: a therapeutic relationship is as effective as an exercise and education intervention for rural amaXhosa women in South Africa

“…This research contributes to understanding the use of non-pharmacological interventions, particularly the effects of therapeutic relationships, to improve pain management for PLWHA, for whom pain is undermanaged internationally [1], and for vulnerable groups, such as women and people in poverty, who commonly receive poor pain management [2,[68][69][70][71]. The current research indicates that the purposeful development of a therapeutic relationship between a caring health care worker and a patient can bring about clinically meaningful changes in pain with significant reductions in pain severity and pain interference for amaXhosa WLWHA.…”

Pain in ambulatory HIV‐positive South Africans

“…Female patients constituted about three quarters of both of our cohorts. That was a higher proportion than the 59% cited for HIV-infected individuals in sub-Saharan Africa (Gray and Berger, 2007), and much higher than the 13%-30% female proportion in studies of HIV-related pain in North America or Europe (Breitbart et al, 1996b;Larue et al, 1997;Frich and Borgbjerg, 2000;Del Borgo et al, 2001;Aires and Bammann, 2005). We recruited our participants from hospitals that provided prenatal and obstetric services, which may have contributed to the extra loading of female patients.…”

Exame direto no diagnóstico de Paracoccidioides brasiliensis realizados nos Laboratórios Regionais do Instituto Adolfo Lutz, São Paulo, Brasil

“…A associação de PCM e AIDS tem sido pouco relatada; e uma das razões é a PCM prevalecer em áreas rurais e a AIDS ocorrer em áreas predominantemente urbanas 20,21 .…”