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Peripheral Neuropathy
Abbye Solis RN, BSN, PCCN
Georgetown University
School of Nursing and Health Studies
Washington, DC USA
Peripheral Neuropathy
Also called….
“Distal Symmetrical Polyneuropathy”, or DSP
Occurs in 1/3 of all HIV+ persons
Causes
Side effect of antivirals (ddI, d4T)
Side effect of TB treatment meds (INH)
Direct attack on neurons by HIV virus
Other causes
Vitamin deficiencies (Vit B12)
Diabetes
Heavy alcohol use
Neurons
Part of one of the layers of the skin
When we touch something, neurons send a signal to our brain which forms our interpretation of what we feel: soft, cold, wet, and hot.
PN
Damage to neurons decreases sensation
Damage to neurons cause alterations to normal function
Alterations in neuronal signaling can cause pain, numbness, tingling, and/or sharp pin-like stabs
Signs and Symptoms
Most common complaint: numbness and burning
Other complaints:
Pin-like pricking, can be vibratory Shooting pains Cold sensation in extremities Leg cramps
Increased in pain at night is common
Progression
Will get worse at the same rate in both hands/arms or feet/legs
Pain can be life altering and dehabilitating
People who have PN are at risk for:
Wounds/Sores
Infections
Depression because of pain
Decreased activity
Treatment of mild pain
If no other NRTI can be used (AZT), reduce d4T by 10mg BID
Treat pain with NSAIDS, Neurontin, or amitriptyline
Treatment of severe pain
Stop all “d-drugs” (ddI, d4T, )
If AZT can be used, start AZT
If AZT cannot be used, stop all ARVs
Treat pain with opiates and Neurontin or amitriptyline
Pain will decrease significantly in 6-8
weeks after stopping medications, but will
not completely go away
Pain Treatment
Mild pain:
NSAIDS Neurontin amitriptylin
e
Severe pain:
Opiate drug
Neurontin amitriptylin
e
Other treatments
Good hygiene of feet
Don’t go out barefoot, if possible
Use walking cane for balance
Stay active
Eat foods high in vitamins
Vitamin supplement: ascorbic acid, multivitamin, vitamin B complex
Peripheral Neuropathy
John is a 47 year old male, diagnosed with HIV 5 years ago, at which time he had a CD4 count of 190 and was started on ARV’s. For the last two years, his viral load has been “undetectable”.
He complains of burning and stiffness in both left foot and toes. He also says he cannot feel most of his right foot when he is walking.
What are some more questions you need to ask him?
Do you take his shoes off to look at his feet?
What can you educate him about today?
Two months later, John complains of his feet burning all the time and he does not get out of bed because “the pain is unbearable”.
He is no longer able to move them without crying out in pain.
What medication can you give him to help with the pain?
John says he wants to stop taking his HIV medications because the pain is so bad. What is your response?