NEW YORK--AIDS patients are vastly undermedicated for their pain,
a new study from Memorial Sloan-Kettering Cancer Center has shown.
While it is well documented that cancer pain continues to be undertreated,
there has been a paucity of data on the adequacy of pain treatment
in HIV disease. The new findings show that only 15% of AIDS patients
receive adequate analgesic therapy, and only 6% of those reporting
severe pain receive a strong opioid, William Breitbart, MD, reported
at the annual meeting of the American Psychiatric Association.
Dr. Breitbart and coworkers evaluated the adequacy of analgesic
management of pain in 366 ambulatory AIDS patients, by using an
established measure for pain assessment--the Pain Management Index
(PMI)--and by determining the type and frequency of analgesic
medications prescribed for pain.
"Our data suggest a striking degree of undertreatment, which
may reflect a lack of physician knowledge regarding pain and pain
management in HIV disease," said Dr. Breitbart, associate
attending psychiatrist. However, in some cases, such undertreatment
may reflect patient related barriers to adequate treatment, he
added. For example, some patients may prefer nonpharmacologic
interventions for their pain.
The frequency and intensity of AIDS-related pain is at least comparable
to and possibly greater than that experienced by cancer patients,
Dr. Breitbart said. The US government has established pain management
guidelines stating that the treatment of pain in HIV disease should
be fundamentally similar to that in cancer.
These guidelines support the use of the World Health Organization
"analgesic ladder" approach for both populations, Dr.
Breitbart said. With this approach, the selection of analgesics
is based primarily on the severity of reported pain. Non-opioid
analgesics--for example, nonsteroidal anti-inflammatory drugs
(NSAIDs)--are recommended for mild pain, while opioid analgesics
are advocated for moderate to severe pain.
The opioids traditionally recommended for moderate pain include
drugs such as codeine or oxycodone, while those suggested for
severe pain include strong opioids such as morphine or hydromor-phone.
Adjuvant analgesic drugs such as antidepressants may be combined
with any of the traditional analgesics to treat residual pain
or neuropathic pain.