Pain in HIV + Patients A drama hard to bear ...
Pain relief or mitigation in seropositive patients is very similar to the treatment of patients who are suffering from neoplasias. Pain is a symptom that is constantly related to patients infected by the Human Immunodeficiency Virus, even in people with CD4 counts in the area of safety and without the presence of opportunistic diseases or AIDS-defining neoplasms such as Kaposi's Sarcoma. The principles of determining and treating pain in HIV patients are in no way different from patients living with cancer and should be prescribed and provided by the State to HIV or with defined AIDS settings.
Pain discourages, tires, abuses and destroys
The prevalence of pain in HIV-infected individuals varies depending on the disease stage, care and treatment methodology. Estimates of the incidence of pain in individuals with HIV show a universe of about 40 to 60%, with a predominance of worsening pain as disease progresses. 38% of outpatients of HIV patients reported major pain in a prospective study of preponderance of pain. Half of those with AIDS reported "some" pain while only a quarter did so early in the chronicity of HIV infection reported some kind of pain. Patients had an average incidence of two or more simultaneous pains that were several times disabling. Recent outpatient reports on HIV-positive men showed that almost thirty percent of those who were asymptomatic patients, slightly more than fifty-five percent of those without AIDS-defining illnesses, and eighty percent of those with AIDS reported one or more painful symptoms for a period of Time greater than half a hundred and eighty days.
A study of Pain in hospitalized HIV + patients revealed that more than half of all patients needed a drug procedure to at least mitigate the pain; With the pain proving to be something like thirty percent of the complaints (index below the prevalence of fever). We noted that slightly more than half, 3%, of patients with advanced stage AIDS treated in nursing homes suffered from pain.
Neuropathy and neuropathic pain make me, Cláudio Souza, from the Soropositivo.Org waking up, often screaming
The pain syndromes most commonly reported in studies to date include neuropathy painful peripheral sensory pain due to prolonged Kaposi's sarcoma, headaches, aches and pharyngeal abdominal, Arthralgia and myalgia, as well as painful skin conditions. Peripheral neuropathies associated with HIV are often painful conditions affecting up 30% of people with AIDS and is characterized by a burning sensation, tingling, or anesthesia in the affected extremity. Several antiviral drugs such as didanosine or salcitabina, chemotherapeutic agents used in the treatment of Kaposi's sarcoma (vincristine), and phenytoin, isoniazid, can also cause painful peripheral neuropathies.
Reiter's syndrome, reactive arthritis, and polymyositis are painful conditions reported early in HIV infection. However, there are a number of other painful rheumatologic conditions in the seropositives including various forms of arthritis (painful joint syndrome, septic arthritis, psoriatic arthritis), vasculitis, Sjogren's syndrome, polymyositis, myopathy due to the use of AZT (Zidovudine) and dermatomyositis.
Conditions associated with chronic or intermittent pain include intestinal infections with microbacteria avium-intracellular and cryptosporidium that cause spasms and intermittent abdominal pain, hepatosplenomegaly, resulting in abdominal distension and pain, oral thrush and esophagus, causing pain while the patient is eating and swallowing and severe spasticity associated with encephalopathy, which causes painful muscle spasms.
Conditions related to HIV that cause acute pain in children include meningitis and sinusitis, which result in severe headaches; Otitis media; Herpes zoster; Cellulitis and abscesses; Severe dermatitis due to candidiasis and dental caries.
Pain and HIV
The HIV-positive patient lives under stressful stress at all levels through the course of their illness, which alters, in extremely different ways for each patient, including dependence, disability and fear of pain, and to mold a very stressful picture, the anxiety with the possibility of an excessively painful death. These frames of anxieties are universal; and psychological distress, and yet even this stress also varies from person to person and depends on social support, family support, in some cases the hard-to-find forgiveness of the spouse and an unlikely individual self-assertiveness , personality type, and medical factors, such as the extent or stage of the disease. In an outpatient study of pain in patients with HIV undergoing treatment, the depression factor was significantly correlated with the presence of pain.
In addition to being significantly more tired and depressed, those with pain (40%) had twice as many suicidal tendencies as those without pain (20%). Pain in HIV + patients was functionally impaired, more depressed, more subject to unemployment or disability, and reported less social support.
Children living with HIV and the pain and HIV related to it in what they euphemistically call communities
Seropositive children, in general, originate in families with low income, large Social vulnerability due to poverty in what today is called "communities" and there is a high prevalence of drug use of all shades, including injectables. Many families have more than one infected limb and multiple losses to AIDS in the same family are common. This affects the way families deal with the disease and, in consequence, the pain it causes. Parental guilt, which usually results in denial of the disease, can also result in denial of the child's pain and resistance to appropriate pain management; On the other hand, users divert the medication that would serve to mitigate the pain of the child and take it to "recreational use" and there is no way for health systems to monitor these events and the child's suffering remains unrelieved by Account of their vulnerabilities together with the lack of ability to communicate in addition to the pressure of parental authority (...).
Fear of addiction and concerns about recreational drug abuse affect both patient acquiescence and clinical administration of opioid analgesics and, as a consequence, leads to submedication of HIV or AIDS patients with pain. One has to put it, unfortunately it is problematic devers treating the pain of patients from the growing segment of HIV recreational drug users.
Drug abuse is also problematic in the pediatric population of HIV. Many HIV-infected children come from families where intravenous drug abuse is or has been a problem. Either they have parents who are active drug users or are in recovery treatment for drug abuse, or live in large families and have had experiences with drug abuse by relatives.
The general treatment of seropositive children is the same as for children with cancer. The control of pain in children in this condition can be complicated by the frequency of encephalopathies and developmental delays related to these social phenomena of difficult solution even in the long or long term.
This would require a large change in legislation, education, customs, the fair distribution of income (an abominable perversity) where great fortunes had to pay high taxes and, in another way, a fierce control, with draconian punishments against corruption at the level the corrupt and corrupting, bringing perhaps in a hundred years some change, I see, with extreme pessimism.
Going back to the scope of the text, where on account of various experiences I wandered, it is usually difficult to determine if a baby with encephalopathy, who can not speak, is living in pain. Careful observation and evaluation of this child's responses to attempts to medicate his or her possible pain, using all caution to avoid drug interactions or impacts on this child's hepatic health, may, and seems to be, the best way to suppress the pain of this child child.
The Vision Problem
Cancer is diagnosed in more than 1 million Americans annually. Cancer causes 1 each 10 deaths worldwide and is increasingly prevalent in the United States, where, according to the American Cancer Society, because 5% of all deaths, about 1.400 deaths per day.
The pain associated with cancer is often poorly treated (sub-medicated) in adults and children. Cancer patients often have problems with multiple pain and difficult to manage. The pain caused by cancer can be due to tumor progression and related disorders (eg .: neurological damage), operations, and other invasive procedures for diagnosis or therapy, with chemotherapy or radiation poisoning, infection, or muscle aches when patients limit physical activities.
The incidence of pain in patients with cancer depends on the type and stage of the disease. When diagnosed at an intermediate stage, the 30 45% of patients have moderate to severe pain. On average, approximately 75% of patients with advanced cancer have pain. Of patients with cancer who have pain, the 40 50% reported it as moderate to severe and the other 25 30% describe it as very severe.
In approximately 90% of patients, the pain resulting from cancer can be controlled by relatively simple means, and also a statement of consensus National Cancer Institute about cancer pain indicates that the "sub-treatment of pain and other symptoms of cancer are a serious problem and neglect of public health. "Institute concluded that" ... every cancer patient should have the expectation of pain control as an integral aspect of their treatment during the course of the disease. "
Due to the control of cancer pain is a problem of international scope, the World Health Organization (WHO) has prioritized each nation gives high priority to establishing a policy of relieving cancer pain. In the United States, many organizations have worked with this goal.
Grief, Loss of Control and Quality of Life
Cancer pain can disappear with the cure of the patient or continue indefinitely as a complication of curative therapies. Despite thinking that cancer pain is often a crisis that emerges in the advanced stages of the disease, it can occur for many reasons and cause suffering, loss of control and quality of life during treatment of the patient, even in patients whose condition is stable and whose life expectancy is long.
Suffering arises from extensive treatment and its consequences for self-esteem and life of the patient, and noted limited options to deal with the symptoms or problems caused by cancer, the sense of personal loss and limitation of hope. "Suffering can include physical pain, but by no means limited to it ... Most often, the pain can be defined as a state of severe wear associated with events that limit a person's integrity ... The suffering of terminal cancer patients can often be alleviated by demonstrating that your pain can actually be controlled. "
The pain can exacerbate the suffering of the individual when he loses hope, become anxious and depressed. The shock and disbelief, followed by symptoms of anxiety and depression (irritability, loss of appetite and sleep, inability to concentrate or to practice everyday activities) are common when people discover they have cancer or discover treatment failed or the disease again manifest. These symptoms usually disappear within a few weeks with the support of family and responsibility, although a sedative medication to make them sleep and reduce your anxiety may be needed at times of crisis. "The relief of suffering and the cure of the disease can be seen as concomitant obligations of the medical professional who actually engaged in the care of patients."
Note: The commitment to alleviating pain is an essential component of clinical management and ethical obligation to benefit without harm; health professionals must remain well informed regarding pain control, even when the current programs do not provide it.
Personal control refers to the ability of individual patients to adapt to immediate circumstances and those arising through personal actions, including:
- predict events,
- have choices of treatment options,
- maintain a repertoire skills for treatment,
- access and use relevant information and
- Access and use social or other support.
Personal control is shaken when the cancer is diagnosed and monitored for continuous pain, invasive procedures or causing sequelae such as amputations, intoxicating treatments, hospitalization and surgery. When the pain reduces the patient's control options, decreases their psychological well-being and make you feel hopeless and vulnerable. Therefore, physicians should support the active involvement of patients in effective and practical methods of pain control.
The quality of life of patients with cancer pain is significantly worse than that of patients without cancer pain.
Pain in patients with cancer or AIDS affects four sectors of the sense of quality of life:
- spiritual and
Relatives and loved ones of patients with pain share, often almost identically to the suffering of this patient for the duration of this suffering, loss of control (of pain) and quality of life, as well as psychological and social stress Which can lead to psycho / psychiatric damages that can be unresolvable in a lifetime. Family members who provide care need to sleep and respect the limits of their care and have socioeconomic needs and fears related to the costs of treatment.
Even in the absence of elements of psychological stress, emotional and physical, the family may feel unprepared to deal with the various needs of the patient. They often need to relieve pain, make decisions about the amount and type of medication and to determine the dose of medication should be given. Sophisticated strategies of pain control require them to deal with complex medication regimens involving parenteral medications or epidural infusions at home.
Some families are reluctant to give adequate doses of analgesics for fear that the patient becomes addicted or dependent or present respiratory deficiencies. Clinicians should reassure patients and families that most pain can be relieved safely and effectively. Family members may feel unprepared to deal with the needs of the patients pain relief or deny the patient feels pain, avoiding face the possibility that the disease is progressing. These situations require ongoing discussions between patients, families and clinicians specializing in pain management.
The pain and the modalities of pain control
The anatomy, physiology and pharmacology of analgesia have been extensively studied. A major breakthrough was the discovery of neurotransmitters that connect the brain to the spinal cord and modulate spinal neurotransmitter activity. These conductors, as well as other spinal cord respond to opioids and other analgesics as well as to experimental and psychological stimuli, including stress to produce analgesia. It was speculated that the activation of this control system by the action of opioids indigenous as B-endorphins and enkefalinas can cause the phenomenon of placebo analgesia and apparent analgesic effect of an acupuncture in some clinical circumstances.
The pain can be defined as "a sensory and emotional experience associated with actual or potential damage of tissue, or described in terms of such damage." Although the mechanisms of pain and its transmitters are being better understood, it should would emphasize that the individual's perception of pain and the assessment of its meaning is a complex phenomenon that involves psychological and emotional processes, in addition to activation of nociceptive transmitters. Pain intensity is not proportional to the type or extent of damaged tissue, but may have influence on the nervous system. The perception of pain depends on the complex interactions between nociceptive impulses and non-nociceptive neurotransmitters upward with respect to the activation of the descending pain inhibitory systems.
This set provides the basis for a comprehensive approach, multi - disciplinary relief and treatment of patients with pain and fits the clinical observation that there is no simple approach to effective pain control. Instead, the individualized control of pain should adapt itself to the stage of the disease, concurrent medical conditions, characteristics of pain and psychological and cultural characteristics of the patient. It also requires continuous assessment of pain and treatment efficacy. The best choice of mode usually changes as the patient's condition and the characteristics of their pain change. It is important that the analgesic effectiveness of the method used separately or in combination to be carefully assessed.
Whenever presence of pain, clinicians should provide effective relief by routine evaluation and treating it with the use of one or more of the embodiments described herein. (But the most correct is the referral to the doctor's clinic pain, which has higher subsidies for appropriate treatment.)
The WHO reports progress in dosages and types of analgesics for effective pain control. When this type of treatment non - invasive is ineffective, alternative modes include other forms of administration of drugs, nerve blocks and ablative neurosurgery. Patients receiving treatment in various degrees of invasiveness can also benefit from other modalities, the numbers of patients receiving these modalities both separately and in combination have not had their cases well documented. There is need for research to determine the effectiveness of many of these procedures used separately or in combination for different patient groups in various segments.
Barriers to Effective Pain Control
Pain control is often hindered unnecessarily. The professionals health are rarely trained to control pain, and may not realize the importance of controlling or even recognize when a patient feels pain, and may be afraid of prescribing opioid medications. As some clinicians, patients and families can avoid using opioids because of their fear of addiction and tolerance, patients can not complain about minor pains. However, it is recommended that clinicians include explanations to patients and families about pain and its control during treatment plan. Another barrier is that pain control is traditionally not a priority in the health care system. Pain treatment is not covered by social assistance or easily accessible and institutions are more concerned with the possible addiction to opioids by patient or other controlled substances that with optimization in pain relief. Clinicians should ensure that patients reluctant to report pain and fear that dependence and uncontrollable side effects, there are ways to relieve pain safely and effectively.
Chat with clinicians to obtain information about pain control, or read this guide and delve into research on the subject, should help patients and their families to overcome their concerns and fears that hinder the effective control of pain.