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HIV and Pain (an oversight in the treatment of HIV).
Within the medical community, it is widely accepted that the pain associated with HIV is comparable to that felt by cancer sufferers. While severe and ongoing pain affects 60% of HIV sufferers, the World Health Organization estimates that in 150 countries HIV pain is severely undertreated. While, it is true that pain by definition is entirely subjective, chronic pain has been proven to lead to depression and more worryingly suicidal intonations.
HIV causes its sufferers pain in any number of ways. The first is a product of the myriad conditions that the compromised immune system of the patient becomes susceptible to. Another way in which HIV causes patients pain is through a condition known as Peripheral Neuropathy, which causes the nerves that carry information from the brain to the rest of the body to malfunction, and leaving its sufferers in excruciating pain. In addition, many HIV patients suffer from intense abdominal pain due to opportunistic infections and the side effects of the Anti-retroviral medication that manages their HIV. Yet another major source of pain is the Herpes Simplex virus, which is frequently found to be co-infecting with HIV due to its opportunistic nature.
However, pain cannot be quantitatively measured, and is entirely subjective. This means that unless a patient verbally expresses pain many clinicians remain entirely unaware of their patient’s suffering. Coupled with the stigma that surrounds HIV and the fact that HIV is rampant in some of the world's poorest and thus medically-deprived areas, and the reasons behind the poor management of HIV pain begin to emerge.
Under The World Health Organization guidelines, pain is first treated with a mild painkiller and if no response occurs then a stronger painkiller is administered until eventually opiates are given. But in undeveloped countries, availability of even the most basic medicine is sporadic and open only to a privileged few. Although access to HIV medicine has improved to 80 % in countries such as Botswana and South Africa, the availability of painkillers is still extremely limited. Added to this is a feeling amongst HIV suffers that pain is merely a factor of having HIV and therefore must be accepted and not questioned.
There are many people that conclude that the UN declaration of health as human right also applies to pain management, as no one can be deemed healthy if they are suffering chronic pain. Therefore, it is imperative that the issue of HIV pain be more widely publicized and addressed. NGOs and global health organizations should set targets to deliver pain relief medicine to developing countries. Pain management must also become entwined with general HIV medicine, and clinicians should provide a comprehensive pain assessment when consulting a HIV patient and educate them about pain management.
1 comment
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Anahita Sharma
Wednesday 16 January 2013, 10:48
Excellent perspective here; thank you! It definitely seems to be an oversight in present treatment focuses.