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(Drug information on codeine) or oxycodone(Drug information on oxycodone), while those suggested for severe pain include strong opioids such as morphine(Drug information on 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.