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Effective Pain Management
By Cheryl Ellis, Staff Writer
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
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
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
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.