When ESKD complicates the management of pain

Abstract

Pain is one of the most common symptoms reported by patients with end‐stage kidney disease (ESKD) and negatively impacts their health‐related quality of life (HRQOL), dialysis adherence, healthcare utilization, and mortality. There are a number of patient‐related and health system‐related barriers that make it very challenging to treat pain in these patients. Moreover, the limited availability of efficacious and safe nonopiate analgesic options has led to over‐use of opioids in this population. We propose a framework for pain assessment and tailored treatment using nonpharmacological and pharmacological approaches to optimize pain management and opioid use. Additionally, we recommend system‐level changes to improve care coordination and pain management in ESKD patients.

Effects of Technology Assisted Stepped Collaborative Care Intervention to Improve Symptoms in Patients Undergoing Hemodialysis

“…The TĀCcare study addresses gaps in the care for this population given that previous work has shown a marked symptom burden that is underrecognized and poorly treated . This is especially true for fatigue and pain, the 2 most prevalent symptoms for which treatment options have been limited to medications and exercise, with studies showing limited efficacy and mixed results . To our knowledge, evidence on fatigue- or pain-specific psychosocial interventions among this population has been very limited and based on small single-center studies with methodologic limitations .…”

“…Limited data suggest there are benefits of analgesic medications for pain; and of sleep hygiene, exercise, and anemia correction for fatigue . However, methodologic limitations of most studies, mixed results on efficacy, adverse events, pill burden associated with pharmacotherapy, and lack of inclusion of robust fatigue- or pain-specific cognitive behavioral therapy (CBT) underscore the need for alternative strategies . Moreover, prior studies have largely focused on treatment of a single symptom, whereas treatment of symptom clusters may be more effective given that many of the physical and mental symptoms frequently coexist, are highly correlated, can exacerbate each another, and may share similar biologic and psychologic pathogenesis …”

“…[14][15][16] However, methodologic limitations of most studies, mixed results on efficacy, adverse events, pill burden associated with pharmacotherapy, and lack of inclusion of robust fatigue-or pain-specific cognitive behavioral therapy (CBT) underscore the need for alternative strategies. 16,17 Moreover, prior studies have largely focused on treatment of a single symptom, whereas treatment of symptom clusters may be more effective given that many of the physical and mental symptoms frequently coexist, are highly correlated, can exacerbate each another, and may share similar biologic and psychologic pathogenesis. 18,19 To address these gaps in symptom management, we designed the Technology Assisted Stepped Collaborative Care (TĀCcare) intervention to target a common symptom clusterfatigue, pain, and depression-and used a flexible approach to offer clinical treatment options that were tailored to individual preferences and treatment responses.…”

Efficacy of Benson's Relaxation Technique on Stress and Pain Among Patients Undergoing Maintenance Hemodialysis: A Systematic Review

“…Pain is one of the most prevalent complaints among PUMH ( Fleishman et al, 2018 ; Jhamb et al, 2020 ), with varying estimates of 74.4% ( Sadigova et al, 2020 ) to 82% experiencing it ( Fleishman et al, 2018 ). Furthermore, around 75% of PUMH reported that their pain was related to ineffective pain management ( Jhamb et al, 2020 ). The pain intensity among PUMH (7.2 ± 2.2) has been rated as mild in 6.1% of cases, moderate in 43.3%, and severe in 50.5% ( Dreiher et al, 2021 ).…”

The Effectiveness of Benson’s Relaxation Technique on Pain and Perceived Stress Among Patients Undergoing Hemodialysis: A Double-Blind, Cluster-Randomized, Active Control Clinical Trial

“…Pain is a highly prevalent symptom among PUH (Marzouq et al., 2021). Approximately 75% of PUH reported that pain was not effectively managed (Jhamb et al., 2020). Nearly three-quarters of PUH reported chronic pain (Sadigova et al., 2020).…”