Patients with chronic conditions often benefited from follow-up visits by nurses. Visits should be multiple, extended over a long-term, and interventions should be individualized. The outcomes may be described as patient satisfaction, good clinical outcomes and cost savings. Future randomized controlled trials should describe nurses' interventions and educational background to enable replication. Randomized controlled trials using the Health Technology Assessment method would permit comparison between studies and be a good foundation for future decision-making.

To determine the prevalence, incidence, and characteristics of pain connected with AIDS, 95 AIDS patients were enrolled in a prospective longitudinal study and interviewed every six months during a 2-year period or until death. The overall incidence of pain was 88%, and 69% of the patients suffered from constant pain interfering with daily living to a degree described as moderate or severe. The most common pain localizations were: extremities (32%), head (24%), upper gastrointestinal tract (23%) and lower gastrointestinal tract (22%). Pain conditions were connected to various opportunistic infections, Kaposi's sarcoma, or lymphoma. Pain in the extremities was predominantly of neuropathic origin (21%). The number of pain localizations increased significantly as death approached (0.8 +/- 1. 0 vs. 1.4 +/- 0.8, p = 0.03). The survival rate for patients without pain at entry was significantly higher than the survival rate of patients in pain, probably related to differences in the duration of AIDS at the time of inclusion. Sustained-release morphine preparations were prescribed in 29% of the patients. Of 39 patients (41%) who died in the department, 7 patients were prescribed continuous intravenous morphine infusion for pain treatment in the terminal phase and 20 patients received short-acting opioids. According to the Pain Management Index (PMI), the patients were insufficiently treated at the beginning of the study. Although the PMI improved significantly during the observation period, the patients felt that pain was not taken seriously by the physicians. However, the patients were convinced that treatment was optimal and, therefore, only 9% of the patients were dissatisfied. Patients were reluctant to take analgesics, primarily because of fear of addiction.

Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction, to investigate whether PC were applicable and to compare these criteria with the ICD-10 criteria. The study was cross-sectional and included 253 patients with chronic pain at a tertiary pain centre. Patients were screened for addiction by a physician and a nurse. The addiction prevalence was 14.4% according to ICD-10 and 19.3% according to PC. A significant difference between the prevalence of addiction according to ICD-10 and to PC was found. The inter-rater reliability was 0.95 for ICD-10 and 0.93 for PC. The sensitivity of PC was 0.85 and the specificity was 0.96. According to PC patients classified as addicted were treated with significantly higher opioid doses, drank more alcohol, smoked more tobacco, used benzodiazepines and had higher levels of depression. According to ICD-10 patients classified as addicted used higher doses of opioids, drank more alcohol and had higher scores of anxiety and depression. High opioid doses, concomitant use of alcohol and younger age were risk factors. The risk profile for PC was different to ICD-10 by adding risk factors as concomitant use of benzodiazepines, having depression and low educational level. PC seems to be appropriate for diagnosing addiction in opioid treated pain patients and seems to be more sensitive and specific than ICD-10 criteria.

Patients with chronic pain may have cognitive dysfunction related to some reversible factors, which can be optimized by therapeutic interventions.

The nurse intervention did not significantly influence patients' health status. Patients in the intervention group tended to use fewer health care resources than those in the control group and the cost of the intervention was more than balanced out by savings in other health care resources.