Prevalence of pain and analgesic adequacy among HIV AIDS patients attending CTC at Muhimbili National Hospital.

Abstract

Pain is a common problem among patients infected with HIV/AIDS. It is often an overlooked symptom requiring clinical intervention 7,10,12,15,28 Several studies have indicated that it is highly prevalent and is dramatically under treated and opioids are rarely used7,10,12 Objective: This study was done to determine the prevalence of pain and the adequacy of analgesia therapy with their associated factors among HIV / AIDS patients attending CTC at MNH. Methodology: Study Design / Study Setting/ Study population: A cross sectional study was conducted at MNH CTC from November, 2008 to March, 2009 and obtained socio demographic data, risk factors for presence of pain, pain severity, and hence determined the analgesic adequacy on adult patients aged> 18 years who responded to structured questionnaire on pain with modified Brief Pain Inventory and assessed the adequacy of analgesia using the pain management Index-PM!. Results: A sample of 250 patients (46.4%) males and (53.6%) females with majority of patients in the age group of 36-50 years with mean age of 38.5 years. 222/250(88.8%) patients had reported to have "frequent or persistent pain" with an average of 1.2 painful sites (range 1-3 sites), and comparable painful sites identified commonly headache, chest skin, joints/muscular and abdominal/oral cavity pains. (93.24%) patients described painful features of nociceptive type (Visceral/somatic) and only 15(6.76%) patients had neuropathic painful features. Many of the patients had moderate pain intensity 154 (69.37%), whilst (9.01 %) and (21.62%) who had severe and mild intensities respectively. 20 (9.22%) of patients with severe pain were given NSAIDS instead of strong opioids such as morphine, whilst 145 (66.82%) of the patients with moderate pain intensity were prescribed NSAIDS instead of weak opioids such as codeine and 44 (20.28%) of patients with mild pain were prescribed non opioids i.e.NSAIDS as recommended.

IX Strong opioids such as oral morphine and weaker opioids or adjuvant drugs were not utilized/ prescribed to any patient according to the reported pain severity. Those using ARV (p=O.022) were significantly found to report presence of pain (76.6%) of patients received inadequate analgesic therapy. Patients with severe pain perception (p=O.OOl), with HIV disease stage3 (p=O.031), and those not using ARV (p=O.024), were most likely to have received inadequate analgesic therapy. Conclusion and Recommendations Results show HIV / AIDS related pain is a prevalent problem and is inadequately treated. It indicates the need to improve HIV / AIDS related pain management. Remedial action including incorporating the existing knowledge on HIV related pain into routine clinical practice, with the cooperation from a multidisciplinary team, allowing frequent V AS and Opioids/ Adjuvants usage according to WHO analgesic ladder at a specialized pain clinic. To keep the VAS and WHO analgesic ladder protocol at CTC and in the patients files for frequent use by the attending physicians and enable serial pain intensity evaluation thus aid in knowing the efficacy of analgesic therapy, so as to lower the prevalence of pain and to provide adequate analgesia to our patients regardless of the patients' disease stage or non ARV use and according to the patients reported pain severity. Future multi centre research is clearly warranted to evaluate the factors that impede adequate pain management and asses the magnitude of the problem of HIV related pain in HAART era in Tanzania, and hence advice on the standard of care to our patients.