1. Nurses SOAR! Training Curricula Series For More Information and Inquiries: nursessoar@georgetown.edu

2. Peripheral Neuropathy Abbye Solis RN, BSN, PCCN Georgetown University School of Nursing and Health Studies Washington, DC USA

3. Peripheral Neuropathy  Also called…. “Distal Symmetrical Polyneuropathy”, or DSP  Occurs in 1/3 of all HIV+ persons

4. Causes  Side effect of antivirals (ddI, d4T)  Side effect of TB treatment meds (INH)  Direct attack on neurons by HIV virus

5. Other causes  Vitamin deficiencies (Vit B12)  Diabetes  Heavy alcohol use

7. 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.

8. 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

9. 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

10. Progression  Will get worse at the same rate in both hands/arms or feet/legs  Pain can be life altering and dehabilitating

11. People who have PN are at risk for:  Wounds/Sores  Infections  Depression because of pain  Decreased activity

12. Treatment of mild pain  If no other NRTI can be used (AZT), reduce d4T by 10mg BID  Treat pain with NSAIDS, Neurontin, or amitriptyline

13. 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

14. Pain will decrease significantly in 6-8 weeks after stopping medications, but will not completely go away

15. Pain Treatment  Mild pain:  NSAIDS  Neurontin  amitriptyline  Severe pain:  Opiate drug  Neurontin  amitriptyline

16. 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

17. 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”.

18. 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.

19. 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?

20. 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.

21. 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?