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					Antiretroviral (ARV) treatment Fact Sheet 18
Palliative care and symptom control

What is palliative care?                                     Why are palliative care and symptom
 Palliative care means care for all the needs of adults
                                                             control important for people with HIV?
  and children with life-threatening or life-limiting         Pain and symptom control often do not receive
  illness, such as HIV/AIDS, cancer or liver disease.          enough attention in HIV care. As a result many
 Palliative care can help people of any age and at            people with HIV suffer unnecessarily from pain and
  any stage of a disease, not just at the end of life.         other symptoms. This might be because of stigma
                                                               and lack of medical treatment, lack of medicines or
 Palliative care has two essential aspects:                   other resources, lack of training in palliative care, or
  - control of pain and other symptoms, including              lack of understanding about how symptoms such as
  the use of powerful pain killing medicines such as           pain can be relieved.
  morphine for severe pain;
  - supportive care that includes counselling,                People with HIV suffer from emotional and social
  psychosocial and spiritual support, home based               effects caused by stigma as well as by illness. There
  care, treatment for illnesses, adequate food, water          is therefore a need for both pain control and
  and shelter, legal help and family support, including        psychosocial support. Palliative care can help both
  school fees and other basic living needs.                    those infected by HIV and those affected by HIV.
 Palliative care can help a person to continue living
  as fully as possible, even if they have a serious          How do they relate to ARV treatment
  illness. If a person is near the end of life, palliative    A person with HIV who is on ARV treatment will
  care also includes care for the dying and support for        usually be able to regain health within months after
  family and friends after a person has died.                  starting treatment and will live for a longer time.
                                                               However, he or she will also need palliative care and
What is symptom control?                                       symptom control at various stages, for example:
                                                               - after diagnosis, if the person has symptoms, for
 Symptoms are the signs or effects of illness; for            example from opportunistic infections;
  example, vomiting can be a sign of problems in the           - at specific times while using ARV treatment, for
  stomach or in a part of the brain.                           example as a result of side effects or if treatment
 Symptom control, sometimes called symptom relief             fails and symptoms start to appear;
  or symptom management, is essential in palliative            - in the later stages of life when the person might be
  care, along with other forms of care and support. It         ill more often, and is less able to cope with
  aims to reduce existing symptoms and to prevent              symptoms or to look after her/himself.
  them before they can cause discomfort or difficulty.        If ARV treatment choices are limited because of side
 Symptom control depends on good supportive care              effects, drug resistance or lack of resources, a
  as well as on medicines for pain and other                   person will benefit from palliative and supportive
  symptoms.                                                    care to help them to continue life as long as
 Psychological and spiritual support, basic physical          possible.
  care, feeling loved and close to other people, and          As well as getting curative treatment for conditions
  reducing stress, are all very important for achieving        such as TB or sexually transmitted infections, people
  good symptom control.                                        with HIV might also need palliative treatment for
 Symptom control can be achieved in a home setting            symptoms caused by pain, for example from
  or in a health facility. If there are sufficient             damaged nerves, herpes infections, or skin and
  resources, it can be helpful to admit a person to a          other problems.
  health facility to get their symptoms assessed and          Symptom control will also be needed if a person
  under control; ongoing symptom control can then              suffers from side effects of ARV treatment or from
  continue in the community.                                   another disease during their life on ARV treatment.




ARVFS18 04/07
What symptoms are most common for                          Continuing or chronic pains are sometimes hard to
someone with HIV?                                           explain in words and a person might believe that
                                                            nothing can be done to help. This type of pain might
 People with HIV can have a wide range of
                                                            not be noticed by others, even if it is severe – the
  symptoms; some of them are caused by HIV itself,
                                                            person might just seem sad, worried or
  some are caused by opportunistic infections, and
                                                            uncomfortable.
  some are caused by side effects of medication.
  Treatment can remove many symptoms, but                  Methods of finding out about pain can include:
  symptom control is also often necessary until the         - asking the person, or the carer, where the pain is,
  treatment works.                                          what it feels like, when it happens, and what makes
                                                            it worse or better;
 Common symptoms for people with HIV include:
                                                            - asking about psychological, social or spiritual
  - Cough or difficulty in breathing
                                                            aspects of the person’s life, to check if these are
  - Serious weight loss
                                                            contributing to the pain;
  - Serious lack of energy or tiredness
                                                            - asking the person or their carer to use a drawing of
  - Fever or sweating
                                                            a human body to show where pains are felt.
  - Sickness, vomiting or diarrhoea
  - Sore mouth or throat
  - Itching or sore skin                                  What medicines are used for pain
  - Worry, sadness or confusion                           control?
  - Pain of various kinds
                                                           Medicines can be used to control pain. They are
 Pain is a very common symptom that is often               called pain killers or analgesics.
  experienced at the same time as most of the other
                                                           Some of these drugs are called opioids or narcotics,
  symptoms mentioned above. It can be a signal of
                                                            such as morphine or codeine. They are more
  problems in: bones, mouth or throat, intestines,
                                                            powerful than other painkillers.
  muscles or nerves (causes of nerve pain include
  herpes zoster, drug side-effects or HIV itself).         Other pain killers are less powerful, such as
                                                            paracetamol, and are useful for less troublesome
 People can also experienced pain because of
                                                            pains. They are sometimes called non-narcotics or
  spiritual, psychological or social problems. To
                                                            non-opioids.
  reduce the pain, the problems must be addressed as
  well as finding out if medication will help.             Some types of pain cannot be controlled even with
                                                            strong pain killers. Different medicines are used for
 Effective pain control can help to reduce stress,
                                                            these, for example drugs that are used for other
  worry and sadness. It is also important to provide
                                                            problems can also control some nerve pains. Some
  emotional support if the person is depressed or
                                                            of these drugs can reduce the effects of ARVs so
  distressed. If a person has other problems they
                                                            should not be used if a person is on ARV treatment.
  should also receive support to deal with these.
                                                           Pain control is achieved by following three steps:
                                                            trying simple pain killers first, then moderate ones,
How can pain be assessed?                                   and then strong ones, until pain is controlled.
 Pain is an unpleasant feeling that can cause distress    Mild or simple analgesics include paracetamol,
  or unhappiness. Many people experience more than          aspirin, ibuprofen or similar drugs.
  one pain at any time – it is important to find out       Moderate (medium) pain killers include weak opioids
  about all the different pains they are experiencing.      such as codeine.
 Some people feel and react to pain very differently      Morphine is the best strong opioid pain killing
  from other people. It is necessary to find out how        medicines. It is usually taken as a liquid, by mouth
  much the pain affects a person. Pain is hard to           either by drinking or through a tube. It is safe to use
  describe in words. It is said that “you area sure         for serious pain, it is easy to administer and it is
  about your own pain, but you are always uncertain         cheap.
  about another person’s pain”. This means that even
                                                           Morphine causes some side effects, especially
  when a person tries to describe his or her pain,
                                                            constipation, some sickness or vomiting, dry mouth,
  another person does not know exactly how it feels.
                                                            occasionally confusion or sleepiness.
 It is important to assess what is causing the pain.
                                                           Medical use of morphine is permitted by law in many
  Different pains need different medicines.
                                                            countries, helping to make good palliative care
 Acute pain is usually easier to explain and               accessible even to people in settings where health
  understand, for example the pain caused by a cut in       services are limited.
  the skin or by a broken bone
ARVFS18 04/07

				
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