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Neuropathic pain in AIDS patients prior to antiretroviral therapy
Abstract
Objective. To measure the prevalence, severity and morbidity of neuropathic pain in AIDS patients, prior to the initiation of antiretroviral (ARV) therapy. Design. A prospective, cross-sectional and descriptiveanalytical study.
Setting. The Kalafong Hospital HIV Clinic in Pretoria. Subjects. All patients with confirmed AIDS who were referred to the Kalafong HIV clinic to be initiated on ARV therapy
during the period August 2006 to March 2007. Outcome measures. Data were collected regarding the presence and severity of neuropathic pain in each subject. Pain of predominantly neuropathic origin (POPNO) was identified using the Neuropathic Pain Diagnostic Questionnaire (DN4). Numerical rating scales (NRS), adapted from the Brief Pain
Inventory, were used to measure pain severity and painrelated interference with six aspects of daily living. Results. Of the 354 patients studied, 20.9% (95% confidence
interval (CI) 16.8 - 25.2%) had POPNO. This pain was significantly more frequent in patients who were male, had lower CD4+ counts or higher viral load levels, and those on TB treatment. Eighty per cent of patients with POPNO experienced significant pain (worst pain severity ≥5 out of 10 on a NRS). Pain-related interference was highest for
enjoyment of life, mood and ability to work. There was a significant positive correlation between severity of pain and pain-related interference for all domains of daily living
evaluated. Conclusions. POPNO results in significant suffering and impaired functioning in patients with AIDS. It is therefore imperative that clinicians assess patients with AIDS for the
presence and severity of neuropathic pain and manage it, using the most recent evidence-based guidelines.
South African Medical Journal Vol. 98 (11) 2008: pp. 889-892
