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

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A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 4: Pain104. Costa D, Mogos I, Toma T. Efficacy and safety of mianserin in the treatment of depression of woman with cancer.Acta Psychiatr Scand 72:85-92, 1985.105. Eberhard G, von Khorring L, Nilsson HL, et al. A double-blind randomized study of clomipramine versusmaprotiline 26 picas in patients with idiopathic pain syndromes. Neuropsychobiology 19:25-32, 1988.106. Feighner JP. A comparative trial of fluoxetine and amitriptyline in patients with major depressive disorder.J Clin Psychiat 46:369-72, 1985.107. Hynes MD, Lochner MA, Bemis K., et al. Fluoxetine, a selective inhibitor of serotonin uptake, potentiatesmorphine analgesia without altering its discriminative stimulus properties or affinity for opioid receptors.Life Sci 36:2317-23, 1985.108. Diamond S, Frietag FG. The use of fluoxetine in the treatment of headache. Clin J Pain 5:200-1, 1989.109. Geller SA. Treatment of fibrositis with fluoxetine hydrochloride (Prozac). Amer J Med 87:594-5, 1989.110. Pick CG, Paul D, Eison MS, Patsernak G. Potentiation of opioid analgesia by the antidepressant nefazodone.Eur J Pharmac 2:375-81, 1992.111. Portenoy RK. Adjuvant analgesics in pain management. In D Doyle, GWC Hanks, N MacDonald, eds. OxfordTextbook of Palliative Medicine, 2nd ed. New York: Oxford University Press, 361-90, 1998.112. Beaver WT, Wallerstein SL, Houde RW, et al. A comparison of the analgesic effect methotrimeprazine andmorphine in patients with cancer. Clinical Pharmacological Therapy 7:436-66, 1966.112. Maltbie AA, Cavenar SO, Sullivan JL, et al. Analgesia and haloperidol: a hypothesis. Journal Can Psychiat40:323-6, 1979.113. Lechin F, Vander Dijs B, Lechin ME, et al. Pimozide therapy for trigeminal neuralgia. Arch Neurol 9:960-64, 1989.114. Breitbart W, Marotta RF, Call P. AIDS and neuroleptic malignant syndrome. Lancet 2:1488, 1988.115. Fernandez F, Levy JK. Psychiatric diagnosis and pharmacotherapy of patients with HIV infection. In Tasman A,Goldfinger SM, Kaufman, eds. Review of Psychiatry, Vol.9. Washington, DC: American Psychiatric Press, 614, 1990.116. Swerdlow M, Cundhill JG. Anticonvulsant drugs used in the treatment of lacerating pains: A comparison.Anesthesia 36:1129-34, 1981.117. Caccia MR. Clonazepam in facial neuralgia and cluster headache: clinical and electrophysiological study.Eur Neurol 13:560-63, 1975.118. Bruera E, Chadwick S, Brennels C, Hanson J, MacDonald RN. Methylphenidate associated with narcotics for thetreatment of cancer pain. Cancer Treat 71:67-70, 1987.119. Forrest H. Dextroamphetamine with morphine for the treatment of post-operative pain.New Eng J Med 296: 712-15, 1977.120. Menza MA, Kaufman KR, Castellanos AM. Modafinil augmentation of antidepressant treatment in depression.J Clin Psychiatry 61:378-81, 2000.121. Fromm GH. Trigeminal neuralgia and related disorders. In Portenoy RH, ed. Pain: Mechanisms andSyndromes. Neurologic Clinics (7). Philadelphia: W.B. Saunders Co., 305-19, 1989.122. Lyndstrom P, Lindbloom T. The analgesic tocainide for trigeminal neuralgia. Pain 28:45-50, 1987.123. Chabal C, Jacobson L, Madano A, Chaney E, Ballell AV. The use of oral mexiletine for the treatment of pain afterperipheral nerve injury. Anesthesiology 76:513-17, 1992.124. Dunlop R, Davies RJ, Hockley J, Turner P. Letter to the editor. Lancet 1:420-1, 1989.125. Brose WG, Cousins MJ. Subcutaneous lidocaine for treatment of neuropathic cancer pain. Pain 45 (2):145-8, 1991.126. Paice J, Ferrans CE, Lahley FR, et al. Topical capsaicin in the management of HIV-associated peripheralneuropathy. J Pain Symptom Manage 19:45-52, 2000.127. Passik S, Breitbart W, Rosenfeld B, et al. AIDS specific patient-related barriers to pain management (Abstract).Proceedings of the 13 th Annual Meeting of the American Pain Society, Miami, FL, Nov 10-13, 1994.128. Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E. Equianalgesic dose ratios for opioids: a critical review andproposals for long-term dosing. J Pain Symptom Manage 22:622-87, 2001.129. McCaffery M, Beebe A. Pain: Clinical Manual for Nursing Practice. St. Louis: RV Mosby Co, 1989.130. JCAHO Pain Standards. www.jcaho.org/standard/pm_hap.html.131. Breitbart W, Kaim M. Rosenfeld B. Clinicians’ perceptions of barriers to pain management in AIDS. J PainSymptom Manage 18:203-12, 1999.122U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau
Chapter 5.26 picas Constitutional SymptomsRocío Hurtado, MD and Eric L Krakauer, MD, PhDINTRODUCTIONV■ Constitutional symptoms, reported by more than 50% of people with advanced HIV disease,often significantly compromise both physical functioning and quality of life. 1-3 The most commonconstitutional symptoms include weight loss, fatigue, fever and sweats. These symptomscan be related to myriad potential etiologies including opportunistic infections, malignancy,metabolic dysregulation, medication-related toxicities and advanced AIDS itself.Attempts should be made to determine and, when possible, treat the underlying causes of constitutionalsymptoms. Yet some underlying causes are refractory to treatment, and in many settingsthe necessary resources remain unavailable. Even where highly active antiretroviral therapy(HAART) is available and the chronic phase of HIV disease is prolonged for many patients,constitutional symptoms may arise from or be exacerbated by cumulative co-existing morbiditiesor by toxicities of the antiretroviral medications themselves.Nevertheless, particularly in the late stages of HIV disease, aggressive symptom managementoften can improve a patient’s quality of life regardless of the effects of more disease-specifictherapies. Thus, it is important that clinicians in all settings be skillful both in controlling uncomfortableconstitutional symptoms and in combining HIV-specific and palliative interventionsfor optimal patient care. The following sections and Table 5-1 address the management ofHIV wasting, fatigue, fever and sweats.HIV WASTING■ HIV wasting syndrome is a common AIDS-defining diagnosis in the United States, with anestimated lifetime frequency of 70% to 90% among AIDS patients who receive no antiretroviraltherapy. 4 It is defined by the Centers for Disease Control and Prevention as an involuntary loss ofmore than 10% of baseline body weight in conjunction with fever, weakness or diarrhea for morethan 30 days. However, less stringent definitions, such as loss of 5% to 10% of ideal body weight,are widely employed in clinical practice. 5Mechanisms of HIV wasting are complex and include the following:• Diminished or inadequate nutrient intake• Excessive nutrient loss• Metabolic dysregulation 6, 7Causes of inadequate nutritional intake often include one or more of the following: dysphagia orodynophagia due to candidiasis, cytomegalovirus, herpes simplex virus, or aphthous ulceration;anorexia, nausea, or vomiting due to infection, malignancy, medication side effects, or othersymptoms such as pain; and psychological factors such as depression, anxiety, grief and loneliness.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 123
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DedicationA Clinical Guide to Suppo
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Lynn A Jansen, RN, PhDAssistant Res
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TABLE OF CONTENTSPart IChapter 1Cha
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IA Clinical Guide to Supportive and
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Chapter 14.26 picasCulture and Care
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Chapter 15.26 picasSpecial Populati
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DRUGS AND THERAPIES INDEXNOTES: Ent
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