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Pain

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Problems and possible causes

For some people in the later stages of AIDS, pain becomes a part of daily life. For others it is only occasional and easily controlled. The causes of pain are many and include:

· immobility

· infections, such as herpes zoster

· swelling of the extremities (caused by poor circulation brought on by Kaposi sarcoma or problems with the heart)

· headache alone or associated with meningitis or encephalitis

· nerve problems including pain with or without weakness

· psychological or emotional causes such as depression and anxiety which may increase the sense of being in physical pain.

What to do at home

In attempting to control and relieve pain, people will need to know that pain is also influenced by the person's emotional state and can be frightening. The sick person may need extra reassurance and care.

Encourage people to look out for any clues as to what increases or relieves pain.

People can take an active role in controlling their pain. For example by:

· learning deep and regular breathing techniques, which may help them to relax

· learning to deal with pain through distraction and lessening of their anxiety - see the section on anxiety and depression in this chapter

· taking medicines for pain according to an organized schedule - this can help people to feel more in control and reassure them that the pain will not become too great before medicine is taken

· engaging in physical activity or receiving gentle massage - both of these can be helpful for some types of pain

· imagining or remembering a favourite place or event.

A person may experience a strong burning sensation, particularly in the hands or feet, which may be due to nerve problems. This type of pain is made worse by extremes of temperature, touch (even clothing or bed sheets) and dryness. The pain is sometimes relieved by putting the legs and feet in water. If the skin seems to be sensitive, then people should plan things so that all the care and activities that require touching are done at the same time, to allow for periods of rest in between. The sick person's bed can be lined with soft blankets or cushions.

If a person experiences any swelling, they should raise their legs or swollen parts on pillows, or raise the foot of the bed on blocks. They should also keep changing their body position.

Treatment for pain of all types may include mild medicines for pain (analgesics) which are commonly used in the home, such as:

· aspirin
· paracetamol.

There are other stronger medicines which people can take for pain but these should only be taken with the advice of a health care worker. See the section on medicines for pain in Chapter Seven for further details.

It is important that the sick person takes the mild pain medicines regularly, at least every eight hours, if the problem is long-lasting or chronic. Waiting until the pain is very severe before taking the medicine makes it less likely to work effectively.

If someone is caring for a person with AIDS who is in pain, you should give them advice which will help them to keep the environment as calm as possible. For example you could advise them to:

· talk slowly to the sick person, and use gentle tones
· approach the person slowly and quietly
· avoid using bright lights
· ask others to be quiet and gentle in the presence of the sick person.

People should also be encouraged to talk with the person, and to provide comfort and distraction from the pain, perhaps by:

· playing favourite music quietly
· reading aloud or telling stories
· applying a cool cloth on the forehead, or giving massage
· asking what relieves the pain and then doing it.

If the sick person is unable to move unaided, they should be helped to change position frequently (see the sections on skin problems, and on tiredness and weakness, in this chapter).

Some people like to be wrapped in a blanket or cloth when they are experiencing pain or to have the painful area wrapped in cloths or a bandage. When someone lifts a child who is in pain, the palms of the hands should be used rather than the fingertips (which can sometimes feel like a pinch).

When sick people and their families must seek help

· If the pain becomes unbearable or is associated with new symptoms such as a severe headache or weakness.

· If there is a sudden or recent occurrence of pain in the hands or feet. People need to be certain it is not due to another illness or medicines for other diseases (see Chapter Seven, section on tuberculosis).

· If there is a persistent headache lasting over two weeks, a severe headache which is getting rapidly worse and is not relieved by the usual ways of dealing with pain, a headache associated with vomiting or a headache that affects the sick person's ability to think or move.

Notes on pain
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