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Effective Pain Management

By Cheryl Ellis, Staff Writer
(Page 3 of 5)

TOLERANCE IS NOT ADDICTION

Caregivers and loved ones may worry that tolerance means addiction, but they are not the same.

Over extended periods of time, the dosage of the medication may need to be increased because the individual has developed a tolerance to the medication, or a rise in pain levels. Doctors work to use the lowest effective dosage to keep the patient alert and pain free.

Medication dependence occurs when there is a physical reliance on the medication and withdrawal symptoms (that are specific to the drug class) occur. There may be tolerance present, but the withdrawal symptoms are noted if the medication is suddenly removed and/or levels of the medicine in the bloodstream decrease.

When addiction is present, caregivers and medical personnel notice that the patient may “lose” prescriptions, and/or take their medications at inappropriate times. A number of other behaviors may be present, including behavioral changes that include isolation from family members.

Rather than diagnose your family member, bring concerns to the family physician to evaluate the situation. What seems like dependence or addiction may be the response to changes in pain level, tolerance or other factors that the doctor must evaluate. Behavioral responses such as anger or depression may be due to poorly controlled pain, especially if the pain control journey is just beginning.

AIDS AND THE PAIN EXPERIENCE

With better medications and awareness on the part of doctors and patients, individuals diagnosed with AIDS are receiving improved care. The pain experience varies from one person to another, even in the AIDS journey.

Neuropathy (“nerve damage”) affects an estimated 20 million Americans according to The Neuropathy Association. Damage to the nerves is caused by the virus, creating burning and sometimes “stabbing” pains in the feet.

In some cases, anti-cancer and retroviral treatments may create their own painful side effects, some of which can be balanced by other medications, including antidepressant therapy.

This immune deficiency virus makes patients of all ages susceptible to yeast infections, throat and mouth sores and other viruses that can attack the body. Bacterial infections are experienced, too and require antibiotics as the doctor decides.

The AIDS patient may have skin eruptions, and these sores or rashes contribute to pain and require treatment. For example, Kaposi Sarcoma is a skin lesion seen in the AIDS patient that initially doesn’t cause pain, but as it becomes worse, pain can be extreme. While Kaposi is not considered “curable”, it can be treated by an oncologist or dermatologist with experience in this area.

Mouth sores or other conditions affecting the mouth can hamper eating, whether the foods are acidic or not. Physicians are familiar with this aspect of the challenges of living with AIDS, and may recommend supplements in addition to other treatment for thrush or mouth sores. Accommodate your loved one’s choices in whether or not to eat at given times, and oversee that medications are taken when ordered, even if alternate routes must be prescribed.

In some cases, individuals with AIDS may have a concurrent infection with the Hepatitis C virus, which also challenges pain management and treatment. When doctors assess for pain in the AIDS patient, they look for other causes of pain, even if the pain felt is typical for an AIDS patient. Hepatitis C is one possibility for a “coinfection”, but other conditions, such as cancers of organs or blood may be present.

Treating the root cause of pain (such as mouth or ear pain from infections) is the doctor’s priority, which is the reason why patients may be at the doctor or hospitalized frequently. The choice is to act quickly to stop infections from causing more problems.

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