Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Nkhoma, Kennedy; Seymour, Jane; Arthur, Antony (2013)
Publisher: BioMed Central
Journal: Trials
Languages: English
Types: Article
Subjects: Educational intervention, Medicine (miscellaneous), Pain, HIV/AIDS, Study Protocol, Palliative care, Pharmacology (medical), Trial, Carers
Background Many HIV/AIDS patients experience pain often due to advanced HIV/AIDS infection and side effects of treatment. In sub-Saharan Africa, pain management for people with HIV/AIDS is suboptimal. With survival extended as a direct consequence of improved access to antiretroviral therapy, the prevalence of HIV/AIDS related pain is increasing. As most care is provided at home, the management of pain requires patient and family involvement. Pain education is an important aspect in the management of pain in HIV/AIDS patients. Studies of the effectiveness of pain education interventions for people with HIV/AIDS have been conducted almost exclusively in western countries. Methods/design A randomised controlled trial is being conducted at the HIV and palliative care clinics of two public hospitals in Malawi. To be eligible, patient participants must have a diagnosis of HIV/AIDS (stage III or IV). Carer participants must be the individual most involved in the patient’s unpaid care. Eligible participants are randomised to either: (1) a 30-minute face-to-face educational intervention covering pain assessment and management, augmented by a leaflet and follow-up telephone call at two weeks; or (2) usual care. Those allocated to the usual care group receive the educational intervention after follow-up assessments have been conducted (wait-list control group). The primary outcome is pain severity measured by the Brief Pain Inventory. Secondary outcomes are pain interference, patient knowledge of pain management, patient quality of life, carer knowledge of pain management, caregiver motivation and carer quality of life. Follow-up assessments are conducted eight weeks after randomisation by palliative care nurses blind to allocation. Discussion This randomised controlled trial conducted in sub-Saharan Africa among people living with HIV/AIDS and their carers will assess whether a pain education intervention is effective in reducing pain and improving pain management, quality of life and carer motivation. Trial registration Current Controlled Trials ISRCTN72861423.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. World Health Organisation: Global HIV/AIDS Response - Epidemic Update and Health Sector Progress Towards Universal Access - Progress Report. Geneva: World Health Organization; 2011.
    • 2. UNAIDS: Global Report: UNAIDS Report on the Global AIDS Epidemic 2010. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2010.
    • 3. Callaghan M, Ford N, Schneider H: A systematic review of task- shifting for HIV treatment and care in Africa. Hum Resour Health 2010, 8:8.
    • 4. Lawson M, Mazengera S, Nkhoma-Mbawa F, Noel T: Malawi Essential Health Services Campaign - Oxfam International Research Report. Oxford, UK: Oxfam; 2008.
    • 5. Makombe SD, Hochgesang M, Jahn A, Tweya H, Hedt B, Chuka S, Yu JK, Aberle-Grasse J, Pasulani O, Bailey C, Kamoto K, Schouten EJ, Harries AD: Assessing the quality of data aggregated by antiretroviral treatment clinics in Malawi. Bull World Health Organ 2008, 86:310-314.
    • 6. Ministry of Health and Population Malawi: The Two Year Plan to Scale Up Antiretroviral Therapy in Malawi. Llongwe, Malawi: Ministry of Health; 2004.
    • 7. McCoy D: HIV Care and Treatment in Southern Africa: Addressing Equity. EQUINET Discussion Paper Number 10. EQUINET and OXFAM GB: Harare, Zimbabwe; 2003.
    • 8. Sabin CA: The changing clinical epidemiology of AIDS in the highly active antiretroviral therapy era. AIDS 2002, 16(Suppl 4):S61-S68.
    • 9. Wantland DJ, Holzemer WL, Moezzi S, Willard SS, Arudo J, Kirksey KM, Portillo CJ, Corless IB, Rosa ME, Robinson LL, Nicholas PK, Hamilton MJ, Sefcik EF, Human S, Rivero MM, Maryland M, Huang E: A randomized controlled trial testing the efficacy of an HIV/AIDS symptom management manual. J Pain Symptom Manage 2008, 36:235-246.
    • 10. Wahab KW, Salami AK: Pain as a symptom in patients living with HIV/ AIDS seen at the outpatient clinic of a Nigerian tertiary hospital. J Int Assoc Physicians AIDS Care (Chic) 2011, 10:35-39.
    • 11. Oldham L, Kristjanson LJ: Development of a pain management programme for family carers of advanced cancer patients. Int J Palliat Nurs 2004, 10:91-99.
    • 12. Newshan G, Sherman DW: Palliative care: pain and symptom management in persons with HIV/AIDS. Nurs Clin North Am 1999, 34:131-145.
    • 13. Newshan G: Pain in human immunodeficiency virus disease. Semin Oncol Nurs 1997, 13:36-41.
    • 14. Harding R, Powell RA, Kiyange F, Downing J, Mwangi-Powell F: Provision of pain- and symptom-relieving drugs for HIV/AIDS in sub-Saharan Africa. J Pain Symptom Manage 2010, 40:405-415.
    • 15. Vogl D, Rosenfeld B, Breitbart W, Thaler H, Passik S, McDonald M, Portenoy RK: Symptom prevalence, characteristics, and distress in AIDS outpatients. J Pain Symptom Manage 1999, 18:253-262.
    • 16. Marcus KS, Kerns RD, Rosenfeld B, Breitbart W: HIV/AIDS-related pain as a chronic pain condition: implications of a biopsychosocial model for comprehensive assessment and effective management. Pain Med 2000, 1:260-273.
    • 17. Hughes J, Jelsma J, Maclean E, Darder M, Tinise X: The health-related quality of life of people living with HIV/AIDS. Disabil Rehabil 2004, 26:371-376.
    • 18. Hughes A: Symptom management in HIV-infected patients. J Assoc Nurses AIDS Care 2004, 15(5 Suppl):7S-13S.
    • 19. Hudson A, Kirksey K, Holzemer W: The influence of symptoms on quality of life among HIV-infected women. West J Nurs Res 2004, 26:9-23. discussion 24-30.
    • 20. Brechtl JR, Breitbart W, Galietta M, Krivo S, Rosenfeld B: The use of highly active antiretroviral therapy (HAART) in patients with advanced HIV infection: impact on medical, palliative care, and quality of life outcomes. J Pain Symptom Manage 2001, 21:41-51.
    • 21. Holzemer WL, Hudson A, Kirksey KM, Hamilton MJ, Bakken S: The revised Sign and Symptom Check-List for HIV (SSC-HIVrev). J Assoc Nurses AIDS Care 2001, 12:60-70.
    • 22. Grant L, Brown J, Leng M, Bettega N, Murray SA: Palliative care making a difference in rural Uganda, Kenya and Malawi: three rapid evaluation field studies. BMC Palliat Care 2011, 10:8.
    • 23. Namisango E, Harding R, Atuhaire L, Ddungu H, Katabira E, Muwanika FR, Powell RA: Pain among ambulatory HIV/AIDS patients: multicenter study of prevalence, intensity, associated factors, and effect. J Pain 2012, 13:704-713.
    • 24. Selwyn PA: Why should we care about palliative care for AIDS in the era of antiretroviral therapy? Sex Transm Infect 2005, 81:2-3.
    • 25. Solano JP, Gomes B, Higginson IJ: A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage 2006, 31:58-69.
    • 26. Peltzer K, Preez NF, Ramlagan S, Fomundam H: Use of traditional complementary and alternative medicine for HIV patients in KwaZuluNatal. South Africa. BMC Publ Health 2008, 8:255.
    • 27. Heath KV, Montaner JS, Bondy G, Singer J, O'Shaughnessy MV, Hogg RS: Emerging drug toxicities of highly active antiretroviral therapy for human immunodeficiency virus (HIV) infection. Curr Drug Targets 2003, 4:13-22.
    • 28. Harding R, Higginson IJ: Palliative care in sub-Saharan Africa. Lancet 2005, 365:1971-1977.
    • 29. Harding R, Karus D, Easterbrook P, Raveis VH, Higginson IJ, Marconi K: Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence. Sex Transm Infect 2005, 81:5-14.
    • 30. Long L, Fox M, Sanne I, Rosen S: The high cost of second-line antiretroviral therapy for HIV/AIDS in South Africa. AIDS 2010, 24:915-919.
    • 31. Goujard C, Bernard N, Sohier N, Peyramond D, Lancon F, Chwalow J, Arnould B, Delfraissy JF: Impact of a patient education program on adherence to HIV medication: a randomized clinical trial. J Acquir Immune Defic Syndr 2003, 34:191-194.
    • 32. Wu AW, Snyder CF, Huang IC, Skolasky R, McGruder HF, Celano SA, Selnes OA, Andrade AS: A randomized trial of the impact of a programmable medication reminder device on quality of life in patients with AIDS. AIDS Patient Care STDS 2006, 20:773-781.
    • 33. StataCorp: Stata Statistical Software: Release 12. College Station, TX: StataCorp LP; 2011.
    • 34. Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977, 196:129-136.
    • 35. Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS: Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004, 20:309-318.
    • 36. Clotfelter CE: The effect of an educational intervention on decreasing pain intensity in elderly people with cancer. Oncol Nurs Forum 1999, 26:27-33.
    • 37. Hudson PL, Aranda S, Hayman-White K: A psycho-educational intervention for family caregivers of patients receiving palliative care: a randomized controlled trial. J Pain Symptom Manage 2005, 30:329-341.
    • 38. Cleeland CS: The Brief Pain Inventory User Guide. Houston: The University of Texas M.D. Anderson Cancer Center; 2009.
    • 39. Breitbart W: Pain management and psychosocial issues in HIV and AIDS. Am J Hosp Palliat Care 1996, 13:20-29.
    • 40. Beck SL, Falkson G: Prevalence and management of cancer pain in South Africa. Pain 2001, 94:75-84.
    • 41. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N, Carr DB, Chandler J, Cowan P, Dionne R, Galer BS, Hertz S, Jadad AR, Kramer LD, Manning DC, Martin S, McCormick CG, McDermott MP, McGrath P, Quessy S, Rappaport BA, Robbins W, Robinson JP, Rothman M, Royal MA, Simon L, et al: Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005, 113:9-19.
    • 42. Ferrell BR, Ferrell BA, Ahn C, Tran K: Pain management for elderly patients with cancer at home. Cancer 1994, 74(7 Suppl):2139-2146.
    • 43. Harding R, Selman L, Agupio G, Dinat N, Downing J, Gwyther L, Mashao T, Mmoledi K, Moll T, Sebuyira LM, Panjatovic B, Higginson IJ: Validation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale. Health Qual Life Outcomes 2010, 8:10.
    • 44. Powell RA, Downing J, Harding R, Mwangi-Powell F, Connor S: Apca: Development of the APCA African Palliative Outcome Scale. J Pain Symptom Manage 2007, 33:229-232.
    • 45. Ferrell BA, Rhiner M, Rivera LM: Development and evaluation of the Family Pain Questionnaire. J Psychosoc Oncol 1993, 10:21-35.
    • 46. Picot SJ, Youngblut J, Zeller R: Development and testing of a measure of perceived caregiver rewards in adults. J Nurs Meas 1997, 5:33-52.
    • 47. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, Haythornthwaite JA, Jensen MP, Kerns RD, Ader DN, Brandenburg N, Burke LB, Cella D, Chandler J, Cowan P, Dimitrova R, Dionne R, Hertz S, Jadad AR, Katz NP, Kehlet H, Kramer LD, Manning DC, McCormick C, McDermott MP, McQuay HJ, Patel S, Porter L, Quessy S, Rappaport BA, et al: Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 2008, 9:105-121.
    • 48. Bennett MI, Bagnall AM, Jose Closs S: How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain 2009, 143:192-199.
    • 49. White IR, Horton NJ, Carpenter J, Pocock SJ: Strategy for intention to treat analysis in randomised trials with missing outcome data. BMJ 2011, 342:d40.
    • 50. Gifford AL, Laurent DD, Gonzales VM, Chesney MA, Lorig KR: Pilot randomized trial of education to improve self-management skills of men with symptomatic HIV/AIDS. J Acquir Immune Defic Syndr Hum Retrovirol 1998, 18:136-144.
    • 51. Lai YH, Guo SL, Keefe FJ, Tsai SL, Chien CC, Sung YC, Chen ML: Effects of brief pain education on hospitalized cancer patients with moderate to severe pain. Support Care Cancer 2004, 12:645-652.
    • 52. Du Pen SL, Du Pen AR, Polissar N, Hansberry J, Kraybill BM, Stillman M, Panke J, Everly R, Syrjala K: Implementing guidelines for cancer pain management: results of a randomized controlled clinical trial. J Clin Oncol 1999, 17:361-370.
    • 53. Lovell MR, Forder PM, Stockler MR, Butow P, Briganti EM, Chye R, Goldstein D, Boyle FM: A randomized controlled trial of a standardized educational intervention for patients with cancer pain. J Pain Symptom Manage 2010, 40:49-59.
  • No similar publications.

Share - Bookmark

Cite this article