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

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 4: PainA comprehensive assessment includes the following:• A careful history and physical examination, which may disclose an identifiable syndrome26(e.g.,picasherpes zoster, bacterial infection, or neuropathy) that can be treated in a standard54, 55fashion• A standard pain history, which may provide valuable clues to the nature of the underlying56, 57process and indeed may disclose other treatable disorders• A description of the qualitative features of the pain, its time course and any maneuvers thatincrease or decrease pain intensityPain intensity (current, average, at best, at worst) should be assessed to determine the need for weakversus potent analgesics and as a means to serially evaluate the effectiveness of ongoing treatment.Pain descriptors (e.g., burning, shooting, dull or sharp) will help determine the mechanism of pain(somatic, nociceptive, visceral nociceptive, or neuropathic) and may suggest the likelihood of patientresponse to various classes of traditional and adjuvant analgesics (nonsteroidal anti-inflammatory58, 59, 60drugs, opioids, antidepressants, anticonvulsants, oral local anesthetics, corticosteroids, etc.).Additionally, detailed medical, neurological and psychosocial assessments (including a history ofsubstance use or abuse) must be conducted. Where possible, family members or partners should beinterviewed and included in the pain management treatment plan. During the assessment phase,pain should be aggressively treated while pain complaints and psychosocial issues are subject to anongoing process of re-evaluation. 56IVPain Measurement/Assessment ToolsPain assessment is continuous and needs to be repeated over the course of pain treatment. Readilyavailable, simple and clinically validated pain self-report measures or tools can make pain assessmenteasier and more reliable. There are essentially four aspects of pain experience in AIDS thatrequire—and can be aided by—ongoing assessment and evaluation:• Pain intensity (see Figures 4-2, 4-3 and 4-4)• Pain relief (see Figure 4-1)• Pain-related functional interference (e.g., mood state, general and specific activities)·• Monitoring of intervention effects.Many pain assessment tools rely on visual analog testing. Three commonly used self-report painintensity assessment tools, illustrated in Figure 4-2, are a simple descriptive pain intensity scale, a 0-10 numeric pain intensity scale, and a Visual Analog Scale (VAS) for pain intensity. The Pain Facesscale, shown in Figure 4-3, can be used with children, patients who do not share a common languagewith the provider, or illiterate patients. The Memorial Pain Assessment Card (MPAC) may also beused, since it is a helpful clinical tool that allows patients to report their pain experience. 61 The MPACconsists of visual analog scales that measure pain intensity, pain relief and mood (see Figure 4-4).The Brief Pain Inventory (BPI) is another pain assessment tool (Figure 4-5) that has been widelyused in cancer and AIDS pain research and clinical settings. 62 The BPI has a useful Pain InterferenceSubscale that assesses pain’s interference in seven domains of quality of life and function.For more information or to download the BPI, go to the Pain Research Group website atwww.mdanderson.org/departments/prg.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 97