Exploration of pain in children on antiretroviral treatment in a regional hospital in South Africa

Abstract

Background: Patients with human immunodeficiency virus (HIV) disease on antiretroviral therapy (ART) may experience pain for a variety of reasons, including the effects of the virus itself, associated opportunistic infections and the ART. Studies indicate that pain in adults on ART is frequent, can be severe, and is often undertreated. This study sought to explore the experience, and the prevalence of pain in young children aged 3-13 years on ART. Method: Primary caregivers of children aged 3-13 years on ART attending a paediatric ART clinic at a regional hospital in Durban participated in the study. Convenience sampling was used. The Wong-Baker FACES™ Pain Rating Scale and a questionnaire adapted from Hirshefeld were used to investigate variables such as age, cluster of differentiation 4 (CD4) count, ART regimen, ART duration, and site, prevalence and impact of pain during activities. Data were analysed using a standard statistical programme. Results: Four hundred and twenty primary caregivers were interviewed. Most were mothers caring for their HIV-positive children, and the majority of the children were aged 3-7 years. Most children were on a first-line ART regimen, and half reported pain. Nociceptive pain (visceral or somatic) was the most common type of pain, and pain interfered with the daily activities of a third of the children. There was a significant association between CD4 count and pain (p-value = 0.040). Paracetamol was the most commonly used analgesic. Conclusion: Pain was a common problem, and generally was undertreated with analgesia. A need to improve pain assessment and management in this population group was identified.