AIDS and Pain

Many of us associate AIDS and pain, but why is that given the availability of high quality pain relief medications in the market? Information from UNAIDs shows that fewer people are dying from HIV/AIDs, but their quality of life is low since they are living in pain (unnecessarily). The main reason behind this problem is that pain in AIDS patients is often taken for granted and goes undiagnosed and untreated. In fact while they may suffer almost the same amount of pain, about 80% of pain in AIDS patients goes untreated as compared to their cancer counterparts.

When it comes to AIDS and pain, the pain can come from any number of causes and can be all consuming, felt anywhere and everywhere in the body, to say nothing of the emotional pain. From HIV opportunistic infections, side effects of the anti-retroviral medication, nutritional deficiencies, to HIV enabled cancers, the causes of pain are numerous and widespread. Generally, a person suffering from AIDS can suffer more than one kind of pain at the same time and this greatly reduces their quality of life. Those most affected are those in the late infection stages and some in the middle stages depending on their quality of life before the infection.

There are barriers that make it difficult for patients suffering from AIDS to access pain medications and we will examine some of them today:

• International barriers in form of all encompassing laws that do not allow for the easy distribution of pain medication. While the convention on narcotic drugs acknowledges the need for narcotic based pain relief medications, in its sub parts it is more determined to curb narcotics use thereby infringing on making them readily available to pain patients.

• Misconceptions when it comes to pain medicating. Many patients are reluctant to report their pain in fear of being considered addicts to pain medication. They feel they will be accused of abusing the medicines and tend to report much lower pain than what they are actually feeling. Another problem is the fear among people that doctors will recommend ever increasing doses of pain medication in an attempt to speed up the death of the patients. This may cause some patients to reject the pain medication altogether. Other fears include everything from patients becoming tolerant to the drugs to them turning into addicts.

• Some nations’ laws are extremely stringent and make the cost of the medication not only high but also create fear among people for having the drugs in their possession. In some cases, doctors are required to take extra exams and then are issued a license just to be able to administer the pain medicines. Elsewhere, the medication is stored in extremely secure facilities and a lot of red tape is involved to gain access to them, and finally they cost a lot of money making them inaccessible to the common man, especially in developing nations.

• The anti-retroviral therapy tends to have painful side effects and in some cases may also interfere with the way the pain medication is absorbed into the body. This may force some caregivers to opt for the continuation of the therapy while largely ignoring the pain it is causing.

• Limited or no access to complementary medication. These are medicines that deal with the side effects of the pain medication and those of the anti-retroviral therapy as well. With these the patient will be able to lead a productive and relatively normal life but the access to them is limited and not much is being done to make them readily available.

In today’s article, we will deal with the physical pain suffered by AIDS patients and how best to deal with it both as a sufferer and a care giver. Ultimately, prevention is always better than a cure but that is neither here nor there.

Pain in HIV patients is perceived by the brain much like any other pain but in this case it is more intense as the immune system has crashed and natural pain inhibitors are not fully functional. Those recently diagnosed and having an early infection are less likely to experience pain, 70% of those in the middle stages of infection suffer one form of pain or another, while almost all those in the advanced stages of the infection will be in pain. Here are some of the pains that people with AIDS are likely to experience:

• Chest pains from either tuberculosis or bacterial pneumonia which are opportunistic infections.

• Headaches which can be either mild or intense depending on the reason causing them such as infection of the nervous system, sinus infection, muscle tension, migraines and stress.

• Pain affecting various areas of the digestive system from throat, stomach, intestines and everything in between. One may get mouth sores and mouth ulcers plus wounds on the lips which may become a problem while eating.

Neuropathic pain of the nervous system usually affecting hands and feet, giving them a numbing or stinging feeling. Approximately 30% of HIV patients experience this kind of pain.

The pain is evaluated the same way other chronic pain is evaluated on a 0-10 scale. 0 is absolutely painless and 10 is the worst pain possible, it is important that the patient describes the pain themselves rather than through someone else. Only the patient can accurately describe their pain and this is important to ensure that the right medication is offered to ensure relief from the said pain.

The first step to treating the pain is to tackle the infection that is causing it in the case of opportunistic infections. Once the infection is healed, the pain will cease as well, but in some cases the actual cause is difficult to pinpoint and the best option is to treat the pain individually.

For mild pain, one can use aspirin or paracetamol and for the more severe pain the person is recommended to try opium based medication or opioids. They will attach themselves to opioid receptors which are proteins found in the digestive tract, spinal cord and brain. They will interfere with the message boards of the pain making it un-perceivable by the brain. The opioids of choice are morphine which is the strongest available and the more mild codeine, they are however not readily available in the less developed world because of various reasons.

In the initial stages, mild pain relief should be offered such as paracetamol, aspirin, and ibuprofen. When the pain increases, then mild opioids should be offered such as codeine, DF118 forte, dextropropoxyphen. In the advanced stages where the pain is all but unbearable then morphine, methadone, fentanyl, and buprenorphine should be offered.

Even less available are adjuvants which are medications meant to deal with the side effects of the pain medication drugs. In some cases, they can be used to relieve pain and enhance the performance of the pain medication.

The major side effects of taking the stronger pain medication are nausea, constipation due to slowed down digestion, dry mouth as well as trouble urinating. To help with this, patients need to take large amounts of water, stay away from alcohol, cigarettes, and caffeinated drinks, eat plenty of roughage (fibre) and general balanced diet as well as maintaining good hygiene orally.

There are some guidelines offered by WHO on how the pain medication should be administered and taken and they are enumerated below:

• Oral medication is the best way to administer the pain relief, as long as the person can still take it.

• The medications that should be taken at regular intervals are recommended by a doctor. This ensures that the pain is kept at bay at all times, this way the patients can live a pain free life.

• To ensure effectiveness, the medication should be taken in a progressive order.

• Each patient is unique and so is their pain and therefore their medication regimen should be tailored to suit them, doctors should assess each patient individually.

With the advancement in medical technology, AIDS and pain do not have to be intrinsically linked any more. Patients can now lead a pain free life at least for the physical pain and this should increase their quality of life greatly. While the treatment aims at increasing their life span, it should not be one riddled with pain, so it is important that pain management for the AIDS patients should be addressed as well. Pain is not part of living with AIDS!

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