Table Of ContentPAIN MANAGEMENT OF AIDS PATIENTS
CURRENT MANAGEMENT OF PAIN
P. Prithvi Raj. Series Editor
The series, Current Management of Pain, is intended by the series
editor and the publishers to provide up-to-date information on
advances in the clinical management of acute and chronic pain
and related research as quickly as possible. Both the series editor
and the publishers felt that, although comprehensive texts are
now available, they do not always cover the rapid advances in this
field. Another format was needed to publish advances in basic
sciences and clinical modalities and to bring them rapidly to the
practitioners in the community. A questionnaire was sent to
selected clinicians and, based on their responses, topics were
chosen by the series editor. Editors of each volume were chosen
for their expertise in the field and their ability to encourage other
active pain specialists to contribute their knowledge:
Ghia, J. N., ed.: The Multidisciplinary Pain Center: Organization
and Personnel Functions for Pain Management, 1988. ISBN
0-89838-359-5.
Lynch, N. T., Vasudevan, S. V.: Persistent Pain: Psychosocial
Assessment and Intervention, 1988. ISBN 0-89838-363-3.
Abram, S.E., ed.: Cancer Pain, 1988. ISBN 0-89838-389-7.
Racz, G.B., ed.: Techniques of Neurolysis, 1989. ISBN 0-89838-
397-8.
Stanton-Hicks, M., ed.: Pain and the Sympathetic Nervous
System, 1989. ISBN 0-7923-0304-0.
Rawal, N., Coombs, D.W., eds.: Spinal Narcotics, 1989. ISBN
0-7923-0374-1.
Stanton-Hicks, M., Janig, W., eds., Reflex Sympathetic Dystro
phy, 1989. ISBN 0-7923-0527-2.
Janisse, T., ed.: Pain Management of Aids Patients, 1991.
0-7923-1056-X.
PAIN MANAGEMENT OF AIDS PATIENTS
EDITED BY THOMAS JANISSE
~.
"
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
Library of Congress Cataloging-in-Publication Data
Pa in management of AIDS patients / edited by Thomas Janisse.
p. cm.-(Current management of pain; 8)
Includes index.
ISBN 978-1-4613-6730-7 ISBN 978-1-4615-3880-6 (eBook)
DOI 10.1007/978-1-4615-3880-6
1. AIDS (Disease)-Complications and sequelae-Treatment.
2. Pain-Treatment. 3. Anesthesia. 4. Analgesia. 1. Janisse.
Thomas. II. Series.
[DNLM: 1. Acquired Immunodeficiency Syndrome-therapy.
2. Ancsthcsia. 3. Pain-prcvcntion & control. Wl CU788LW v. 8/
WD 308 P144]
RC607.A26P35 1991
616.97'9206-dc20
DNLM/DLC
for Library of Congress 90-15622
CIP
Copyright © 1991 by Springer Science+Business Media New York
Originally published by Kluwer Academic Publishers in 1991
Softcover reprint ofthe hardcover Ist edition 1991
AII rights reserved. No part ofthis publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise,
without the prior written permission ofthe publisher, Springer Science+Business Media, LLC.
Printed on acid-free Paper
To my family,
Cherryl, Laura, and Jill,
Emile, Rita, Richard, Joanne, and John.
To P. Prithvi Raj, Jim, Vickie, and Steve.
Who offered me an opportunity.
CONTENTS
Contributing authors IX
Series editor's comment Xl
Preface xiii
1. Etiology, pathogenesis, and diagnosis
thomas janisse
2. Psychoneuroimmunology and AIDS 15
sanford i. cohen,
susan blumenthaul
3. Anesthetic management of AIDS patients 37
ernest r. greene, jr.
thomas janisse
4. Management of the parturient with AIDS 61
m. joanne douglas
5. Oro facial pain in AIDS patients 73
douglas w. anderson
marshall d. bedder
6. Chronic pain syndromes in AIDS patients 91
richard I. rauck
Index 115
CONTRIBUTING AUTHORS
Douglas W. Anderson Sanford I. Cohen
Adjunct Instructor of Anesthesiology Professor of Psychiatry
Pain Management Service Director, Stress and Behavioral
Department of Anesthesiology Medicine Center
Oregon Health Sciences University Department of Psychiatry
3181 SW Sam Jackson Park Road Department of Miami School of
Portland, Oregon 97201 Medicine
Miami, Florida 33136
Marshall D. Bedder
Assistant Professor of Anesthesiology
M. Joanne Douglas
Assistant Professor of Surgery
Associate Clinical Professor of
Division of Neurosurgery
Anaesthesiology
Director, Pain Management Service
Division of Obstetric Anaesthesia
Oregon Health Sciences University
The University of British Columbia and
3181 SE Sam Jackson Park Road
Grace Hospital
Portland, Oregon 97201
4490 Oak Street
Vancouver, British Columbia, Canada
Susan Blumenthaul
V6H 3V5
Chief, Behavioral Medicine Program
Health and Behavior Research Branch
Division of Basic Sciences Ernest R. Greene, J r.
National Institute of Mental Health Associate Professor of Anesthesiology
5600 Fishers Lane University of Alabama at Birmingham
Rockville, MD 20857 Chief of Anesthesia
x Contributing Authors
Veterans Administration Medical Richard L. Rauck
Center and Cooper Green Hospital Assistant Professor of Anesthesiology
700 South 19th Street Director, Pain Control Center
Birmingham, Alabama 35233 Bowman Gray School of Medicine
2240 Cloverdale A venue
Thomas Janisse Winston Salem, North Carolina 27103
Chief of Anesthesia
Director, Pain Service ILLUSTRATOR
Department of Anesthesia
Stephen Bachhuber
Kaiser Sunnyside Medical Center
Staff Anesthesiologist
10200 SE Sunnyside Road
Department of Anesthesia
Clackamas, Oregon 97215
Kaiser Sunnyside Medical Center
10200 SE Sunnyside Road
Clackamas, Oregon 97215
SERIES EDITOR'S COMMENT
Acquired immunodeficiency syndrome has become a significant health
problem in the practice of medicine today. While the research in AIDS is being
funded and progressing at a rapid rate, the cure for this syndrome is not yet in
sight. Most of the advances are in diagnosis and screening of patients with
latent AIDS. In addition, literature is profusely replete with its epidemio
logical consequences and health care cost to the society. As far as this editor
knows, no publication is available on the pain syndromes associated with
AIDS. Furthermore, the incidence, severity, and duration of such pain
syndromes are unknown. It is therefore necessary that pain syndromes caused
by AIDS should be addressed and evaluated and the therapeutic plans
rationalized for this unfortunate group of patients.
Tom Janisse has undertaken this task and with the help of his coauthors,
produced an excellent monograph that is unique and, I hope, useful for
decreasing the suffering of AIDS patients.
Prithvi Raj
PREFACE
Thousands of articles and many books have been published on the acquired
immunodeficiency syndrome (AIDS). There are, however, no studies or case
reports and only several articles published on the anesthetic considerations for
a person with AIDS or in pain with AIDS. There is no literature on the pain
management of AIDS patients. Writing on this subject must be considered
trailblazing.
The reason anesthesiologists should know about AIDS has rapidly extended
from concern over transmission of infection to anesthetic and analgesic
considerations. The anesthesiologist may also be part of a pain management
team on either an acute or a chronic pain service. The requirement may be to
treat an HIV -positive or AIDS patient acutely postoperatively or in consult to
a psychiatric, medical, or surgical service. In a pain clinic setting, the
anesthesiologist may be concerned with diagnosis, treatment, or referral for
other multidisciplinary consultation.
The earlier question of central nervous system involvement in AIDS is now
moot, rapidly replaced with the knowledge that the eNS, if not primarily
infected, is so shortly thereafter. Protected by the blood-brain barrier, the
eNS becomes both a sanctuary and reservoir for HIV. Because neurologic
complications of HIV are common, and since knowledge of the nervous
system is essential for anesthetic and pain management, it is important to
review HIV infection of the nervous system. In chapter 1, I introduce the
subject of HIV infection and discuss the significant nervous system alterations
as a foundation for the discussions in the following chapters.
