It's OK to Treat HIV-Related Pain

Today's article from pain.com (see link below) discusses the fact that, as a general rule, HIV-related pain is not treated as well as it could be. There is a reluctance to treat pain with stronger drugs (opiates etc) either because they may be addictive, or because it's too expensive, or because it's culturally unpopular. Yet most pain can be controlled with careful administration of drugs (some neuropathy sufferers may disagree) and there's really no reason for patients to suffer unduly, or feel that they have to live through the pain. It's important to remember that we're talking about pain that lasts more than a few months (chronic pain) and not the everyday aches and pains that most people have.

Are HIV/AIDS Patients Undertreated for Pain?
December 15, 2011

Not all HIV/AIDS patients will suffer from chronic pain problems, but studies suggest that the prevalence of chronic pain is high in HIV/AIDS patients, with over half of HIV/AIDS patients reporting complaints such as chronic headaches, severe abdominal pain and peripheral neuropathy. The treatments for HIV/AIDS have improved drastically since the beginning of the HIV/AIDS epidemic, with antiretroviral drugs extending the lives of infected patients. These drugs transformed a diagnosis of HIV/AIDS from a death sentence into a struggle with a serious, yet manageable condition. The question still remains: Are the pain complaints of HIV/AIDS patients being addressed to the fullest potential, or are HIV/AIDS patients undertreated for pain?

Studies examining this question have come to the conclusion that pain is indeed undertreated in HIV/AIDS patients, even in developed countries with modern hospitals and the available resources to treat pain. It appears as though the two main agents we have for treating pain related to HIV/AIDS, opioid pain medications and antidepressant medications, are both prescribed to HIV/AIDS patients less than would be expected. Opioid pain medications, also called narcotics, are very effective at treating all types of pain except pain due to nerve damage. Antidepressants and certain types of anti-seizure medications are more effective for neuropathy and some chronic pain conditions in which narcotics are not a good long-term pain management solution. When rates of pain treatment in HIV/AIDS and cancer patients are compared, HIV/AIDS patients receive far less treatment for pain than cancer patients, even though prevalence rates for pain are similar in both diseases.

There are a lot of different reasons that can explain why pain is grossly undertreated in HIV/AIDS patients. In some cases, patients may not understand that their pain can be treated and effectively managed, so they might not seek help for their pain complaints. They may feel as though it is necessary to suffer through pain if you have HIV/AIDS and that nothing can be done about it, even though this is not true. Other patients may fear the side effects of pain medications or becoming addicted to narcotic pain medications. Other possibilities include the patient feeling as though they already have to take too many medications and that this may harm them, and lack of communication between the doctor and the patient. In some cases, the cost and availability of the medications may be an issue. Doctors may also fear being punished for prescribing pain medications to patients too often. Overall, the reasons why pain is undertreated in HIV/AIDS patients vary depending on many factors, but things can be done to improve the situation, including better communication between doctors and patients about pain management.

In undeveloped and developing countries, the situation is even worse for treatment of HIV/AIDS and the management of the pain involved with the disease. For example, in Kenya, HIV/AIDS treatment statistics have actually improved in a very short period of time. Twenty-five percent more people with HIV/AIDS have access to antiretroviral drugs in Kenya in 2011 than they did in 2010. Obviously, efforts to increase the availability of these drugs for HIV-infected people in Kenya has paid off. However, the availability of drugs such as morphine in tablet form for pain relief is incredibly low. Because of this, many HIV/AIDS patients can manage their disease with antiretroviral drugs, but their pain may go completely untreated regardless of the severity of the pain. There are also commonly issues with HIV-infected children suffering from chronic pain; doctors are reluctant to use morphine to treat a child, even if it means that not doing so will mean that the child has to live with chronic pain that could have been managed.

Palliative care and pain management are extremely important components of treatment for HIV/AIDS patients all over the world. Since there are so many different reasons why pain is undertreated in HIV/AIDS patients, there is no quick solution to the problem. However, improved communication between doctors and patients and increased availability of pain medications can improve the situation.

http://pain.com/library/2011/12/15-hivaids-patients-undertreated-pain/