title: An educational intervention to reduce pain and improve pain management for Malawian people living with HIV/AIDS and their family carers: study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Many HIV/AIDS patients experience pain often due to advanced HIV/AIDS infection and side effects of treatment. In sub-Saharan Africa, pain management for people with HIV/AIDS is suboptimal. With survival extended as a direct consequence of improved access to antiretroviral therapy, the prevalence of HIV/AIDS related pain is increasing. As most care is provided at home, the management of pain requires patient and family involvement. Pain education is an important aspect in the management of pain in HIV/AIDS patients. Studies of the effectiveness of pain education interventions for people with HIV/AIDS have been conducted almost exclusively in western countries.
  
  
  METHODS
  A randomised controlled trial is being conducted at the HIV and palliative care clinics of two public hospitals in Malawi. To be eligible, patient participants must have a diagnosis of HIV/AIDS (stage III or IV). Carer participants must be the individual most involved in the patient's unpaid care. Eligible participants are randomised to either: (1) a 30-minute face-to-face educational intervention covering pain assessment and management, augmented by a leaflet and follow-up telephone call at two weeks; or (2) usual care. Those allocated to the usual care group receive the educational intervention after follow-up assessments have been conducted (wait-list control group). The primary outcome is pain severity measured by the Brief Pain Inventory. Secondary outcomes are pain interference, patient knowledge of pain management, patient quality of life, carer knowledge of pain management, caregiver motivation and carer quality of life. Follow-up assessments are conducted eight weeks after randomisation by palliative care nurses blind to allocation.
  
  
  CONCLUSIONS
  This randomised controlled trial conducted in sub-Saharan Africa among people living with HIV/AIDS and their carers will assess whether a pain education intervention is effective in reducing pain and improving pain management, quality of life and carer motivation.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN72861423.
authors.affiliation: Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.
authors.forename: Kennedy
authors.initials: K
authors.lastname: Nkhoma
authors.forename: Jane
authors.initials: J
authors.lastname: Seymour
authors.forename: Antony
authors.initials: A
authors.lastname: Arthur
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D017028:Caregivers / Q000523:psychology*; D002985:Clinical Protocols; D007722:Health Knowledge, Attitudes, Practice; D006779:Hospitals, Public; D006801:Humans; D008295:Malawi; D009042:Motivation; D010044:Outpatient Clinics, Hospital; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010166:Palliative Care; D010174:Pamphlets; D010353:Patient Education as Topic; D011237:Predictive Value of Tests; D011788:Quality of Life; D012107:Research Design; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome