Determine the site of the pain and grade the severity of the pain. Pain control in adults should be achieved as follows:
Initially use non-opioids such as aspirin 600mg every 4 hours, increasing to 1000mg every 6 hours, or paracetamol 500mg every 4 to 6 hours, or ibuprofen 400mg every 6 hours.
The next level of treatment for pain control is with a mild opioid such as codeine given in a dose of 30mg every 4 hours. If this still does not control pain then a strong opioid such as morphine may be used initially in a dose of 5mg every 4 hours. This dose should be increased to levels that control pain.
Chronic pain should be treated by month and on a regular basis. It is advisable to start with mild analgesia and progress in a step-wise to more potent analgesics and opioids if necessary. The pain control "ladder" is shown in Figure 8.1.
Figure 3: Achieving pain control in persons with chronic pain
Patients with AIDS often develop severe breathlessness terminally. This may be the result of a severe non-responding lung infection or cancer such as Kaposi’s sarcoma or lymphoma affecting the lungs and pleura. In such patients alleviate dyspnoea by propping up the patient and then refer for further management.
Vomiting may lead to poor fluid intake and hence dehydration and therefore it is necessary to correct dehydration. Patient should be encouraged to take small amounts of fluids frequently. Vomiting may be relieved by administering prochlorperazine 5mg PO TID or metoclopromide 10mg PO TID.
Good oral care should always be practiced. This includes regularly brushing the teeth with a soft toothbrush and gargling with mouth wash solutions or weak salt solutions after food. In persons with mouth sores oral care helps. If the sores are painful patients will not be able to eat or swallow and should be given soft foods and liquid diets. If a specific cause for the ulcers is found these should be treated as described.
To relieve itching, bath oils or other emollients such as emulsifying ointment may be useful. If a rash is present then antifungal creams will help if the rash is due to a fungal infection or topical steroids will relieve inflamed areas of the skin if a bacterial or viral infection is not present. Orally administered antihistamines, such as, diphenhydramine or hydroxyzine 25mg PO given at night may reduce the pruritus and allow a relatively more comfortable sleep.
Prevent the development of bedsores by changing the position of the patient every 4 hours and arrange for the patient to lie on an extra soft material. Avoid pressure on any one part of the body for prolonged periods of time. Protect areas that have become inflamed because of pressure by avoiding any pressure at all on the area and by applying soothing lotions. Change soiled bed sheets immediately. Massage pressure points such as the heels, elbows, ankles, back and hips frequently. Cover all open sores with a gauze bandage after applying an antiseptic cream.