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Management of chronic pain in chronic kidney disease

Author
Sara N Davison, MD, MHSc, FRCP(C)
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

Pain is one of the most common and distressing symptoms among patients with chronic kidney disease (CKD). The prevalence of pain has been associated with substantially lower health-related quality of life and greater psychosocial distress, insomnia, and depressive symptoms [1-9]. Many analgesics that are typically used in the non-CKD population should not be used among CKD patients. This topic reviews the management of chronic pain among CKD patients.

The evaluation and management of pain in the general adult population is reviewed elsewhere. (See "Definition and pathogenesis of chronic pain" and "Overview of the treatment of chronic non-cancer pain".)

EPIDEMIOLOGY

Pain is more prevalent among CKD patients than in the general population. Over 60 percent of hemodialysis patients describe moderate or severe chronic pain [10-13]. By contrast, according to a national survey, approximately 19 percent of adults in the United States (both with and without CKD) have reported chronic pain, although prevalence rates increase with age and peak in adults aged 60 to 69 years at 29.6 percent [14]. (See "Definition and pathogenesis of chronic pain", section on 'Epidemiology'.)

Most studies of CKD patients have included only hemodialysis patients [13]. A few small studies have suggested that pain is as common among peritoneal dialysis patients and stage 5 CKD patients who are not on dialysis as among chronic hemodialysis patients [10-12].

Very few studies have reported the prevalence of pain among patients with earlier stages of CKD. A single, small study of 130 nondialysis CKD patients with varying severity of CKD suggested that the prevalence of pain was similar (64 to 75 percent) among all levels of CKD patients [15]. However, it is not clear that patients included in this study are representative of CKD patients in the general population, since all patients in this study were drawn from a CKD clinic; many individuals with mild declines in estimated glomerular filtration rate (eGFR; ie, 60 to 90 mL/min/1.73 m2) are not followed in CKD clinics.

                   

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Literature review current through: Nov 2016. | This topic last updated: Thu Jun 23 00:00:00 GMT+00:00 2016.
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