Pain management

Question 1

Causes of pain in patient with HIV/AIDS

Answer 1

oral cavity - aphthous ulcers, candida, herpes
abdominal pain - UTI, colitis, pancreatitis, hepatitis
headaches - sinusitis, meningitis, encephalitis
neuromuscular - encephalopathy
ears - otitis media and externa
skin - sores and rashes
chest - pneumonia/ TB
ART side effects - diarrhoea, headache, muscle pain
procedural pain

Question 2

Components of total pain

Answer 2

social
emotional
physical
spiritual

Question 3

Pharmacological management pain in 5 year old according to WHO

Answer 3

Level 1: non-opioid analgesics - NSAIDS and paracetamol
Level 2: weak opioids with/ without non-opioids - Valeron
Level 3: strong opioids with/ without non-opioids - Morphine

Question 4

Special considerations according to WHO

Answer 4

by the clock
- for persistent pain use a regular schedule
- give breakthrough doses if needed
- not prn unless episodes are truly irregular and unpredictable
by the mouth
- give orally when possible - simplest, most effective, least painful
- if oral route is not an option DON’T use IMI route (very painful) rather consider IV, PR, SC, or transdermal
by the individual
- dose paracetamol and NSAIDS according to weight
- consider capacity to metabolise
- malnourished children will have a low metabolism
- opioids should be titrated in steps
- best possible pain relief with acceptable side-effects