THE UNDERTREATMENT OF PAIN IN AMBULATORY AIDS PATIENTS

Pain is highly prevalent in individuals with HIV disease, yet is often overlooked as a symptom requiring clinical intervention. We evaluated the adequacy of analgesic management for pain and identified predicto rs of pain undertreatment in a sample of 366 ambulatory AIDS patients using a prospective cross-sectional survey design. Two hundred and twe nty-six of the 366 ambulatory AIDS patients surveyed reported ''persis tent or frequent'' pain over the 2 week period prior to the survey. Ad equacy of analgesic therapy was assessed using the Pain Management Ind ex (PMI - a measure derived from the Brief Pain Inventory) and the typ e and frequency of analgesic medications prescribed for pain. Results indicated that nearly 85% of patients were classified as receiving ina dequate analgesic therapy based on the PMI. Less than 8% of the 110 pa tients who reported ''severe'' pain were prescribed a ''strong'' opioi d (e.g., morphine), as suggested by published guidelines. Adjuvant ana lgesic drugs (e.g., antidepressant medications) were prescribed in onl y 10% of the patients. Women, less educated patients, and patients who reported injection drug use as their HIV transmission risk factor wer e most likely to have received inadequate analgesic therapy. These res ults demonstrate the alarming degree of undertreatment of pain in ambu latory patients with AIDS, and indicates the need to improve the manag ement of AIDS-related pain in this underserved population. Future rese arch should elucidate the factors that impede adequate pain management in order to overcome obstacles to adequate treatment.