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Mucositis
10. Opioids, via PCA or a continuous infusion, provide effective analgesia in mucositis, however
PCA is associated with reduced opioid requirements and pain duration (U) (Level I
[Cochrane Review]).
11. Topical treatments, including oral cooling or povidone‐iodine solution, provide effective
analgesia in mucositis (N) (Level I).
12. Oral laser light therapy reduces mucositis pain and progression (N) (Level II).
Pharyngitis
13. Steroids improve analgesia in sore throat, in particular in severe and exudative conditions
(N) (Level I).
14. Paracetamol, nsNSAIDs or coxibs and opioids, administered as monotherapy or in
combination, are effective analgesics in acute pharyngitis (N) (Level I).
15. Steroids may reduce acute pain associated with severe pharyngitis or peritonsillar abscess
(following drainage and antibiotics) (N) (Level II).
The following tick box represents conclusions based on clinical experience and expert
opinion.
Recurrent or persistent orofacial pain requires biopsychosocial assessment and
appropriate multidisciplinary approaches. Neuropathic orofacial pain (atypical odontalgia,
phantom pain) may be exacerbated by repeated dental procedures, incorrect drug therapy
or psychological factors (U).
9.6.8 Acute pain in patients with HIV infection
Pain is a common problem in people infected with HIV, particularly when they develop the
AIDS. Pain may be due to the effects of the virus, which is neurotropic, or an infective or
neoplastic process associated with immunodeficiency. Pain may also be a side effect of
treatment or related to debilitation (in patients with end‐stage AIDS) or may be due to an
CHAPTER 9 In patients with HIV/AIDS, pain is progressive, affecting approximately 25% with early stage
unrelated comorbidity (O'Neill & Sherrard, 1993; Glare, 2001).
disease, 50% to 75% with AIDS and almost all patients in the terminal phase (Singer et al, 1993
Level IV; Breitbart, McDonald et al, 1996; Kimball & McCormick, 1996). CD4+ T‐cell count does not
predict number of symptoms or severity of distress (Vogl et al, 1999 Level IV).
Pain occurs at multiple sites with the number of pains reported per patient increasing
throughout the course of AIDS. The most frequent neurological diagnosis is a distal
symmetrical polyneuropathy (DSP), found in 38% or patients. Common clinical features of DSP
include non‐painful paresthesias (71%), abnormalities of pain and temperature perception
(71%), and reduced or absent ankle reflexes (66%). Increased age, immunosuppression, poor
nutritional status and the presence of chronic disease all contribute to distal peripheral nerve
dysfunction associated with HIV infection (Tagliati et al, 1999 Level IV).
Pain associated with HIV/AIDS is often undertreated due to patient and clinician‐related
barriers (Breitbart, Rosenfeld et al, 1996; Level IV; Larue et al, 1997; Breitbart et al, 1998; Breitbart et
al, 1999; Frich & Borgbjerg, 2000). Therefore patients cite poorly treated pain as one of the most
common reasons to use complementary or alternative medicines (Tsao et al, 2005 Level IV).
Undertreatment is more common in certain patient groups — non‐Caucasians, women, those
with a substance abuse disorder, less educated individuals, and those with higher levels of
psychosocial distress (Breitbart et al, 1998 Level IV). Physical and psychological symptoms
278 Acute Pain Management: Scientific Evidence
