The pharmacologic management of pain and discomfort in persons with AIDS near the end of life: use of opioid analgesia in the hospice setting.

To determine the prevalence and management of pain and discomfort during the last 2 weeks of life in persons with acquired immunodeficiency syndrome (AIDS) being cared for in hospice settings, and to find the extent to which opioids are used for relief of pain and discomfort during this period, we conducted a retrospective cohort study of patients treated by AIDS hospice agencies in Seattle, Washington (1987-1992). The medical records for the last 2 weeks of life were reviewed for 185 consecutive adults with AIDS who were receiving hospice care. Most [93% (172/185)] experienced at least one 48-hr period of pain and discomfort during the last 2 weeks of life, with prevalence increasing from over one-half of the cohort early in the 2-week course to two-thirds of the cohort late in the course; 88% (162/185) received some form of opioid analgesia (0-100 mg/hr morphine equivalent), with the majority [62% (100/162)] experiencing some relief thereafter. Ten of the 172 with pain and discomfort did not receive an opioid drug; 4 had relief anyway. Among the 7% (13/185) who did not report pain and discomfort during the last 2 weeks of life, 4% (8) received opioid analgesia. Pain and discomfort in persons with AIDS approaching the end of life is a common experience. Opioids are frequently given in widely varying dosages (and dosing strategies), with variable results. Some patients require high doses yet continue in pain; others are comfortable on no medication. The majority of patients receive opioid medications and experience relief from pain and discomfort.