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4.3.2 – Sensory functions and pain

Pain is a complex and multifaceted issue in every child living with HIV. All children infected with HIV should be assessed for pain. If available a pain specialist should be consulted.

Both pharmacological and non-pharmacological treatments should be considered. Ensuring the child's comfort is also an important component of pain management, including using a gentle touch when moving or supporting a client and providing cushioning and supports.

Pain is associated with a lower quality of life, a low CD4 count, more significant immunosuppression and mortality. Girls and younger children describe higher pain levels, specifically gastrointestinal and limb related, than older children and boys. Any pain is important to note, but of particular importance is pain that is new or different.

Pain can be measured using modified visual analogue pain scales and rating measures, e.g., the Wong and Baker Faces Pain scale. These measures can be adjusted according to age, degree of illness and other factors, such as cultural background and beliefs.

Potential causes of these impairments and rehabilitation interventions are shown in the table below.

Table 4.3.2: Clinical Aspects of Sensory Functions and Pain

Impairments Possible Etiologies Rehabilitation Interventions4
Pain
(acute and chronic)

HIV

HIV-related infections

Side effects of medication

Resulting from diagnostic and therapeutic interventions

Non-pharmacological Interventions for pain

  • Relaxation techniques
  • Massage therapy
  • Distraction
  • Free play time
  • Music
  • Sleep
  • Rest
  • Balanced diet
  • Warm bath
  • Transcutaneous Electrical Nerve Stimulation (TENS)

Pharmacological interventions are also important and can include:

  • Topical analgesics
  • Local anaesthetics
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroids
  • Anticonvulsants with analgesic effects
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Narcotics

4Choice of rehabilitation interventions will depend on patient assessment and available resources.