Treatment of pain in patients with renal insufficiency: The World Health Organization three-step ladder adapted

Launay-Vacher, Vincent; Karie, Svetlana; Fau, Jean-Baptiste; Izzedine, Hassane; Deray, Gilbert

doi:10.1016/j.jpain.2004.11.009

Cited by 53 publications

(29 citation statements)

References 96 publications

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“…This is likely the major factor contributing toward both the under-and overprescription of opioids in this population (7,8,13,33). The World Health Organization recommendations for opioid therapy in acute and chronic malignant pain exist, but it is uncertain whether these can be extrapolated to nonmalignant pain and to patients with ESRD (34,35). The need for specific guidelines to treat pain in ESRD is paramount, given the potential for increased adverse effects discussed above.…”

Section: Discussionmentioning

confidence: 99%

Opioid and Benzodiazepine Use in End-Stage Renal Disease

Wyne

Rai

Cuerden

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Chronic pain and psychiatric disorders are common in dialysis patients, but the extent to which opioids and benzodiazepines are used is unclear. We conducted a systematic review to determine the: (1) prevalence of opioid and benzodiazepine use among dialysis patients; (2) reasons for use; (3) effectiveness of symptom control; and (4) incidence of adverse events.Design, setting, participants, & measurements Two authors reviewed all relevant citations in MEDLINE/ EMBASE/CINAHL/BIOSIS Previews/Cochrane and hand-searched bibliographies. Studies after 1990 reporting prevalence estimates for opioid and/or benzodiazepine use in Ն50 dialysis patients were included. ResultsWe identified 15 studies from 12 countries over 1995 to 2006. Sample size ranged from 75 to 12,782. Prevalence of opioid and benzodiazepine use was variable, ranging from 5 to 36% (95% CI, 4.1 to 45.5%; n ϭ 10) and 8 to 26% (95% CI, 7.1 to 27.3%; n ϭ 9), respectively. Prevalence was positively correlated with years on dialysis. Five studies reported on the same cohorts but gave different prevalence estimates. One study verified medication use through patient interviews. Reasons for use were reported in one study. Effectiveness of pain control varied from 17 to 38%, and 72 to 84% of patients with significant pain had no analgesia (n ϭ 2). No study rigorously examined for adverse events. ConclusionsThe prevalence of opioid and benzodiazepine use in dialysis patients is highly variable between centers. Further information is needed regarding the appropriateness of these prescriptions, adequacy of symptom control, and incidence of adverse effects in this population.

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Section: Discussionmentioning

confidence: 99%

Opioid and Benzodiazepine Use in End-Stage Renal Disease

Wyne

Rai

Cuerden

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…This places them at a higher perioperative risk of opioid-induced respiratory depression, necessitating consideration of opioid-reducing strategies such as early fracture fixation, regular simple analgesia (but not non-steroidal anti-inflammatory drugs [7,22]) and regional nerve blockade.…”

Section: Discussionmentioning

confidence: 99%

An analysis of renal dysfunction in 1511 patients with fractured neck of femur: the implications for peri‐operative analgesia

White¹,

Rashid²,

Chakladar³

2009

Anaesthesia

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SummaryFollowing two deaths from respiratory failure secondary to opioid toxicity in patients admitted for surgical repair of fractured neck of femur, we retrospectively studied the serum urea and electrolyte concentrations of 1511 consecutive patients requiring surgery for proximal femoral fracture, and calculated their glomerular filtration rate. Five hundred and forty-five (36.1%) patients had renal dysfunction on admission (glomerular filtration rate < 60 ml.

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“…Among opioids, tramadol is generally well-tolerated by patients with renal impairment; in fact, tramadol (50 mg every 12 hours) has been recommended for patients whose creatinine clearance is below 10 mL/min. and for dialysis patients [62,63]. A study showed that tramadol does not alter renal blood flow in normal rats or in those with experimentally induced renal insufficiency which provides the rationale for using tramadol in patients with renal insufficiency [64].…”

Section: Use Of Opioids In Cancer Patients With Renal Impairmentmentioning

confidence: 99%

“…Thus, renal tolerance is the only criterion that should be considered in the administration of these drugs to these patients. For hemodialysis patients, renal tolerance is not an issue and exacerbation of pain at the end of hemodialysis is a well-known phenomenon [63]. It is not clear how to manage episodic pain in hemodialysis patients, but non-dialyzable drugs offer a possible solution.…”

mentioning

confidence: 99%

Current concepts of pain management for cancer patients

2008

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Pain management is one of the most important issues confronted when treating patients with malignant diseases. Since its release/publication in 1986, the World Health Organization's three-step analgesic ladder has helped to greatly improve pain management in cancer patients. However, many questions about this three-step analgesic ladder have been raised and its application in the clinical setting remains a controversial subject. This review article explores the frontline treatment of cancer pain with morphine and the different routes of fentanyl administration used in cancer pain management. The combination of multiple opiates/opioids has been shown to result in more effective cancer pain management; however, the exact benefits of such opiate/opioid combinations have yet to be established. This article also discusses recent advances in the topical application of morphine and in the combination of ketamine and morphine. It explores the updated treatment principles of neuropathic pain in advanced-stage cancer patients, which incorporate the use of anti-depressants, anti-convulsants, and opioids. Finally, this article reviews the available data and clarifies the general principles for using opioids in cancer patients with renal insufficiency. We hope that this information will be helpful in improving pain management in cancer patients and in facilitating further research.

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Treatment of pain in patients with renal insufficiency: The World Health Organization three-step ladder adapted

Cited by 53 publications

References 96 publications

Opioid and Benzodiazepine Use in End-Stage Renal Disease

Opioid and Benzodiazepine Use in End-Stage Renal Disease

An analysis of renal dysfunction in 1511 patients with fractured neck of femur: the implications for peri‐operative analgesia

Current concepts of pain management for cancer patients

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