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

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 4: PainNON-PHARMACOLOGIC INTERVENTIONS■ Physical interventions, psychological therapies and neurosurgical procedures may also proveuseful in the management of HIV-related pain (see Table 4-9).26 picasTable 4-9: Non-pharmacologic InterventionsPHYSICAL THERAPIESIVCutaneous stimulation (superficial heat, cold, and massage)Transcutaneous electrical nerve stimulation (TENS)AcupunctureBed restPSYCHOLOGICAL THERAPIESHypnosisRelaxation, imagery, biofeedback, distraction, and reframingPatient educationNEUROSURGICAL PROCEDURESNerve blocksCordotomyPhysical interventions range from bed rest and simple exercise programs to the application of coldpacks or heat to affected sites. Other non-pharmacologic interventions include whirlpool baths,massage, the application of ultrasound and transcutaneous electrical nerve stimulation (TENS).Increasing numbers of AIDS patients have resorted to acupuncture to relieve their pain, with anecdotalreports of efficacy.Several psychological interventions have demonstrated potential efficacy in alleviating HIV-relatedpain, including hypnosis, relaxation and distraction techniques such as biofeedback and imagery,and cognitive behavioral techniques.See Tables 4-10 and 4-11 for sample relaxation and distraction exercises.Where non-pharmacologic and standard pharmacologic treatments fail, anesthetic and evenneurosurgical procedures (such as nerve block, cordotomy, and epidural delivery of analgesics) areadditional options available to the patient who appreciates the risks and limitations of theseprocedures.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 115