Pain Management in Chronic Kidney Disease
Pain is common in patients with advanced chronic kidney disease (CKD), experienced by 50–70 % of CKD patients. Pain is often not recognized by renal clinicians and therefore remains untreated. Routine symptom assessment is integral to quality CKD care. Pa
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Edwina A. Brown and Sara N. Davison
Before You Start: Facts You Need to Know
• Pain is common in patients with chronic kidney disease (50–70 % patients depending on study) and is often not recognized. • Pain is related to comorbidities and causes and complications of chronic kidney disease. • Pain can be controlled safely in patients with kidney disease, including those on dialysis. • Pain medication should be prescribed in a logical manner using a pain-control ladder. • Pain adversely affects quality of life so must not be ignored.
E.A. Brown, DM (Oxon), FRCP Imperial College Kidney and Transplant Centre, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK e-mail: [email protected] S.N. Davison, MD, MSc (*) Department of Medicine and Dentistry, University of Alberta Hospital, 11-107 Clinical Sciences Building, Edmonton, AB T6G2G3, Canada e-mail: [email protected]
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Pain in CKD
Pain is common – we have all experienced it. Unlike most things treated in medicine, the experience of pain is entirely subjective. We can recognize situations where we expect pain, such as fractures, tissue damage due to surgery, ischaemia, etc., but the pain itself is perceived differently by each individual. Pain can therefore only be diagnosed if we ask patients whether they have pain and how this is affecting them. How pain is experienced depends on many factors including culture, social support, mood as well as the pathology causing the pain. Often patients will not complain about chronic pain as they feel that this is part of their illness, that the healthcare team is not interested, or that any medication they have tried has been ineffective or has had side effects. Ideally, this should not happen as pain is known to be associated with depression and adversely affects quality of life.
22.1.1 Causes of Pain It is not surprising that patients with CKD have such a high pain burden. As shown in Table 22.1, pain can be due to the underlying kidney disease, complications of poor kidney function, dialysis itself and comorbidities [1–3]. Determining the cause of pain therefore requires careful history taking. Indeed, patients may have often more than one cause of pain [1–3].
M. Arici (ed.), Management of Chronic Kidney Disease, DOI 10.1007/978-3-642-54637-2_22, © Springer-Verlag Berlin Heidelberg 2014
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298 Table 22.1 Causes of pain related to CKD Primary kidney disease
Comorbidity
Complications of CKD
Haemodialysis
Peritoneal dialysis
Transplant
Some specific causes of kidney disease can be associated with significant and often severe pain, even at stages when kidney function itself is not impaired. Examples include: Polycystic kidneys Pain from bleeding into or rupture of cysts in kidney or liver Infection of cysts in kidney or liver Back pain from lumbar lordosis caused by abdominal distension from size of kidneys and/or liver Renal calculi – infection and obstruction Ischaemic heart disease – angina Peripheral vascular disease – claudication, ischaemic ulcers Diabete
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