The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

More documents

Recommendations

Info

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 4: Pain• Painful Neuropathies According to Stage of HIV Infection26 picasIn general, the type of neuropathy varies with the stage of infection, 29 as follows:• The acute or seroconversion phase of HIV disease is associated with mononeuritides,brachial plexopathy and acute demyelinating polyneuropathy• The latent or asymptomatic phase (CD4+ T lymphocytes >500/mm 3 ) is characterized byacute and chronic demyelinating polyneuropathies• The transition phase (200-500 CD4+ cells) is characterized by herpes zoster (shingles)and mononeuritis multiplex• The late phase of HIV disease (
A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 4: Pain• HIV-associated myopathy or polymyositis• Necrotizing non-inflammatory myopathy in association with zidovudineand without zidovudine26 picas• Pyomyositis• Microsporidiosis myositisPolymyositis may occur at any stage of HIV infection; it is thought to be the result of direct viralinfection of muscle cells 40 and may present with a sub-acute onset of proximal muscle weakness andmyalgia. 45 Electromyographic evidence of myopathy, a raised serum creatinine kinase, and biopsyevidence of polymyositis are common in symptomatic patients. Drugs used in the treatment of HIVdisease may also be associated with the development of myalgia 26 and myositis. 46, 52 Zidovudine hasbeen particularly implicated; symptoms frequently improve following discontinuation of zidovudinetherapy. 10IVOVERVIEW OF PAIN MANAGEMENT IN HIV/AIDS■ Optimal management of pain requires a multidisciplinary approach. The initial assessment shouldshed light on etiology and contributing factors as well as establish a baseline from which to monitorthe impact of therapy. Pain assessment tools for noting the intensity of pain, time, dose, and impactof medications are discussed below. Clear communication between provider and patient/family isimportant to monitor the impact of any intervention (see Chapter 21: Patient-Clinician Communication).WHO Pain LadderChoice of analgesic agents should follow the World Health Organization’s pain ladder(see Figure 4-1):• Non-narcotic analgesics are the first step, for mild pain• Weak opioids are the second step, for moderate pain• Strong opioids are the third step, for severe painIt is important that providers be comfortable with the use of one or two medications in each analgesicstep (see Tables 4-6, 4-7 and 4-8), including management of side effects; conversion from one step,or level, to another; drug interactions (see Chapter 27: Pharmacologic Interactions of Clinical Significance);and dosing schedules.Adjuvant treatments are important components of the pain ladder and have key roles in AIDS, particularlyin management of neuropathic pain.Assessment IssuesDame Cicely Saunders introduced the concept of total pain in the early years of the hospicemovement in the United Kingdom. 53 This approach emphasizes the need to keep in mind psychological,social, and spiritual aspects as well as physical aspects when approaching a patient in pain.Therefore, a close collaboration of the entire health care team is optimal when attempting to adequatelymanage pain in the AIDS patient.The initial step in pain management is a comprehensive assessment of pain symptoms. A healthprofessional in the AIDS setting must have a working knowledge of the etiology and treatment of painin AIDS, including an understanding of the different types of AIDS pain syndromes discussed as wellas a familiarity with the parameters of appropriate pharmacologic treatment.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 95
Page 4 and 5:
DedicationA Clinical Guide to Suppo
Page 6 and 7:
Lynn A Jansen, RN, PhDAssistant Res
Page 9 and 10:
TABLE OF CONTENTSPart IChapter 1Cha
Page 11 and 12:
IChapter 1.26 picasHIV and Palliati
Page 13:
IA Clinical Guide to Supportive and
Page 16 and 17:
A Clinical Guide to Supportive and
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 47 and 48:
IIIChapter 3.Assessment of Physical
Page 49 and 50:
Page 51 and 52:
Page 53 and 54: A Clinical Guide to Supportive and
Page 93: A Clinical Guide to Supportive and
Page 145 and 146: Chapter 6.26 picasPulmonary Symptom
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165:
Page 168 and 169:
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
Page 177 and 178:
Chapter 8.26 picasOral ProblemsDavi
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Chapter 9.26 picasDermatologic Prob
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Chapter 10.26 picasPsychiatric Prob
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Chapter 11.26 picas Substance Use P
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275:
Page 278 and 279:
Page 280 and 281:
Page 282 and 283:
Page 284 and 285:
Page 286 and 287:
Page 288 and 289:
Page 290 and 291:
Page 292 and 293:
Page 294 and 295:
Page 296 and 297:
Page 298 and 299:
Page 300 and 301:
Page 302 and 303:
Page 304 and 305:
Page 306 and 307:
Page 308 and 309:
Page 311 and 312:
Chapter 14.26 picasCulture and Care
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Chapter 15.26 picasSpecial Populati
Page 327 and 328:
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
Page 335 and 336:
Page 337:
Page 340 and 341:
Page 342 and 343:
Page 344 and 345:
Page 346 and 347:
Page 348 and 349:
Page 350 and 351:
Page 352 and 353:
Page 354 and 355:
Page 356 and 357:
Page 359 and 360:
Chapter 17.26 picasEthical IssuesLy
Page 361 and 362:
Page 363 and 364:
Page 365 and 366:
Page 367 and 368:
Page 369 and 370:
Page 371 and 372:
Page 373 and 374:
Page 375 and 376:
Chapter 18.26 picasLegal and Financ
Page 377 and 378:
Page 379 and 380:
Page 381 and 382:
Page 383 and 384:
Page 385 and 386:
Page 387 and 388:
Page 389 and 390:
Page 391 and 392:
Page 393 and 394:
Page 395 and 396:
Page 397 and 398:
Chapter 19.Palliative 26 picas Care
Page 399 and 400:
Page 401 and 402:
Page 403 and 404:
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
Page 417:
Page 420 and 421:
Page 422 and 423:
Page 424 and 425:
Page 426 and 427:
Page 428 and 429:
Page 430 and 431:
Page 432 and 433:
Page 434 and 435:
Page 436 and 437:
Page 438 and 439:
Page 441 and 442:
Chapter 21.26 picas Patient-Clinici
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Page 451 and 452:
Page 453 and 454:
Page 455:
Page 458 and 459:
Page 460 and 461:
Page 462 and 463:
Page 464 and 465:
Page 466 and 467:
Page 468 and 469:
Page 470 and 471:
Page 472 and 473:
Page 474 and 475:
Page 476 and 477:
Page 478 and 479:
Page 480 and 481:
Page 482 and 483:
Page 484 and 485:
Page 486 and 487:
Page 489 and 490:
Chapter 23.26 picas Medical Care in
Page 491 and 492:
Page 493 and 494:
Page 495 and 496:
Page 497 and 498:
Page 499 and 500:
Page 501:
Page 504 and 505:
Page 506 and 507:
Page 508 and 509:
Page 510 and 511:
Page 512 and 513:
Page 515 and 516:
Chapter 25.26 picas Prevention of S
Page 517 and 518:
Page 519 and 520:
Page 521 and 522:
Page 523 and 524:
Page 525 and 526:
Chapter 26.26 picasResourcesMagda B
Page 527 and 528:
Page 529 and 530:
Page 531 and 532:
Page 533 and 534:
Page 535 and 536:
Page 537 and 538:
Page 539 and 540:
Page 541 and 542:
Page 543 and 544:
Page 545 and 546:
Page 547 and 548:
Page 549 and 550:
Page 551 and 552:
Page 553 and 554:
Page 555 and 556:
Page 557:
Page 560 and 561:
Page 562 and 563:
Page 564 and 565:
Page 566 and 567:
Page 568 and 569:
Page 570 and 571:
Page 572 and 573:
Page 574 and 575:
Page 576 and 577:
Page 578 and 579:
Page 580 and 581:
Page 582 and 583:
Page 584 and 585:
Page 586 and 587:
Page 588 and 589:
Page 590 and 591:
Page 592 and 593:
Page 594 and 595:
Page 596 and 597:
Page 598 and 599:
Page 600 and 601:
Page 602 and 603:
Page 604 and 605:
Page 606 and 607:
DRUGS AND THERAPIES INDEXNOTES: Ent
Page 608 and 609:
Page 610 and 611:
Page 612:
show all

The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

Create successful ePaper yourself

Delete template?

Save as template?