Evaluation of recalcitrant pain in HIV-infected hospitalized patients.
Chronic refractory severe pain in HIV-infected patients is a common and often neglected problem. Little data exist evaluating its epidemiology, clinical features, and treatment. Our study assessed all HIV-infected inpatients referred to the pain control service over a 2-year span. All (24) inpatients with HIV infection with chronic refractory severe pain referred to the pain control service (PCS) over a 2-year period were prospectively followed daily by trained specialists who graded the pain, recommended appropriate therapy, and assessed outcome. Ten surviving patients had further long-term outpatient follow-up. The patients included 14 intravenous drug abusers, five of whom were on methadone maintenance. Localized lower-extremity pain was present in 58%. Pain had been present for > or = 1 month in 21 (88%) and for > or = 6 months in 12 (50%). No patient had been on pain control around the clock. After PCS consultation, all surviving patients (21 of 21, 100%) had partial or total pain relief within 2 weeks (eight within 1 week) using around-the-clock opioid analgesia adjusted daily as necessary. No differences were seen between substance abusing/methadone patients and others. No significant adverse reactions or new addiction problems were found. Our conclusion is that effective pain control can be achieved using around-the-clock opioid analgesia in terminal HIV-infected patients with severe, chronic, refractory pain, even if the patients are substance abusers.
Anand
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Department of Medicine, Nassau County Medical Center, East Meadow, New York.
Carmosino
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Glatt
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D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D002908:Chronic Disease; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010098:Oxycodone / Q000627:therapeutic use; D010146:Pain / Q000150:complications* / Q000188:drug therapy; D015819:Substance Abuse, Intravenous / Q000150:complications
D009020:Morphine; D010098:Oxycodone; D005283:Fentanyl