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THE PREVALENCE OF PAIN IN PATIENTS WITH HIV/AIDS: A CROSS SECTIONAL SURVEY
ABSTRACT
Pain is a common symptom experienced by people infected with the human
immunodeficiency virus (HIV), particularly in the later stages of the disease when they
develop the Acquired Immune Deficiency Syndrome (AIDS). Pain in HIV infection has
multiple aetiologies, including the HIV infection itself, opportunistic infections, AIDS
related malignancies, and medication toxicities. With the advent of highly active anti
retroviral therapy (HAART), HIV disease has been transformed from a terminal illness
to a chronic condition, with more patients living long enough to experience painful
conditions. Despite the large burden of HIV infection, there is paucity of data on pain
in HIV/AIDS patients in Nigeria.
This cross sectional descriptive study was carried out to determine the prevalence of
pain among HIV/AIDS patients, and to determine the common pain sites, pain severity,
c0ommonly prescribed analgesics for pain in HIV/AIDS patients and their
effectiveness. Three hundred HIV positive adult patients 18 years and above visiting an
antiretroviral treatment facility (Special Clinic) were studied using an interviewer
administered questionnaire and a Brief Pain Inventory (BPI) to obtain information on
pain. A Pain Management Index (PMI) was constructed to determine the adequacy of
pain management.
The prevalence of pain was 24.7%. The most common pain sites reported included
the legs (19%), the head (15%), joints(13%), waist (9%), soles of feet (8%), abdomen
(8%), chest (6%), palms (5%), shoulder ((4%), and back (4%), with up to 29.8% of the
patients reporting more than one pain site. Pain was reported by 21.6% as mild (1-3),
58.1% as moderate (4-6) and 20.3% as severe (7-10) on the numerical rating scale. Of
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the patients that had pain, only 32.4% had analgesia prescribed for them. Non-opioids
were prescribed in 79.2% of patients who received analgesia, with only 13.3% of the
patients receiving a weak opioid. None of the patients had strong opioids prescribed for
them. Commonly prescribed analgesics included paracetamol (29.2%), ibuprofen
(25.0%), diclofenac (20.8%), pentazocine (12.5%), tramadol (8.3%) and
cabamazepine(4.2%). Sixty percent of the patients with severe pain had no form of
analgesia prescribed for them. Overall, pain management was inadequate with a
negative Pain Management Index (PMI) scores in 91.9% of patients and only 8.1% of
the patients with pain having a PMI of zero, indicative of adequate pain management.
Pain is a significant and debilitating symptom affecting multiple sites concurrently
in patients with HIV/AIDS and is grossly undertreated. Involvement of pain specialists
in their management will bring about improvement in the overall quality of health care
of these patients.
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