Pain in Chronic Kidney Disease: A Scoping Review

Abstract

There is increasing international attention in efforts to integrate palliative care principles, including pain and symptom management, into the care of patients with advanced chronic kidney disease (CKD). The purpose of this scoping review was to determine the extent, range, and nature of research activity around pain in CKD with the goal of (i) identifying gaps in current research knowledge; (ii) guiding future research; and (iii) creating a rich database of literature to serve as a foundation of more detailed reviews in areas where the data are sufficient. This review will specifically address the epidemiology of pain in CKD, analgesic use, pharmacokinetic data of analgesics, and the management of pain in CKD. It will also capture the aspects that pertain to specific pain syndromes in CKD such as peripheral neuropathy, carpal tunnel syndrome, joint pain, and autosomal dominant polycystic kidney disease.

Survival by Dialysis Modality—Who Cares?

“…Dialysis patients experience a high symptom burden for years, similar to that of patients with terminal cancer receiving palliative care (41,42), and symptoms correlate robustly with poorer quality of life after adjustment for depression (42). More than 58% of dialysis patients experienced chronic pain, and, of these, half rated the pain as moderate to severe (43). It would be instructive and sobering to know how many years patients like these survive with pain.…”

<b>Características definidoras dos diagnósticos de enfermagem identificados nos indivíduos em hemodiálise/ Defined characteristics of the nursing diagnosis identifield on individuals in hemodialysis<b>

“…Estudiosos ressaltam a importância do conhecimento do profissional de saúde, inclusive do enfermeiro, para uma melhor assistência, reduzindo danos e incapacidades e promovendo a qualidade de vida de pacientes em fases de adaptação e reabilitação (19) . (20) . Percebe-se, assim, que várias características definidoras estão presentes na clientela renal crônica em hemodiálise.…”

Pain, Analgesics, and Safety in Patients with CKD

“…A substantial body of literature has shown that .58% of dialysis patients report pain, and 49% of these patients rate their pain as moderate or severe (1). However, surprisingly little is known about the prevalence and nature of chronic pain in patients with earlier stages of CKD.…”

“…Chronic pain is associated strongly with considerable disability, lower health-related quality of life (HRQL), and burden to the healthcare system (1,6,7). The nephrology community has recognized this and has begun to advocate for routine screening and management of pain as a way to promote patient-centered, outcome-oriented, quality health care.…”

“…When faced with a CKD patient with chronic pain, several key issues should be considered to mitigate potential harm (1). Analgesics should be used as part of a comprehensive treatment program that includes physical therapy and psychologic and behavioral approaches to pain management.…”