Pain and Chronic Kidney Disease

Document Type

Journal Article

Publication Date

1-1-2015

Journal

Chronic Renal Disease

DOI

10.1016/B978-0-12-411602-3.00071-8

Keywords

Chronic kidney disease; Pain; Quality of life

Abstract

© 2015 Elsevier Inc. All rights reserved. There are several studies that evaluate the deleterious impact of pain in patients with CKD. The prevalence of pain has been estimated at approximately 50-70% in patients with advanced CKD. The causes of pain in CKD patients are often unrelated to the renal disease and can be categorized as neuropathic (pain due to nerve damage) or nociceptive (pain due to tissue damage) in nature. There are a variety of validated screening tools available to determine the location, degree, and quality of a patient's pain and any exacerbating or alleviating factors. These tools include, but are not limited to, the McGill Pain Questionnaire, Edmonton Symptom Assessment System, and the Brief Pain Inventory. A thorough evaluation should be undertaken to determine the underlying etiology of a patient's acute or chronic pain syndrome. Management of pain can be divided into non-pharmacologic and pharmacologic options. Non-pharmacologic alternatives should be considered before prescribing chronic pain medications. Pharmacologic treatment should follow specific guidelines with careful selection of appropriate analgesics and dose reduction for reduced eGFR, as most commonly used pain medications and their metabolites are renally cleared with a higher risk for adverse events in CKD. Opioids should only be used for severe pain refractory to other measures including non-opioid and adjuvant analgesics. Greater provider awareness and a multidisciplinary approach including assessment and management of concurrent psychosocial issues are likely required to adequately address the pain epidemic in CKD.

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