Measuring pain in patients undergoing hemodialysis: a review of pain assessment tools

Upadhyay, Chandani; Cameron, Karen; Murphy, Laura; Battistella, Marisa

doi:10.1093/ckj/sfu067

Cited by 34 publications

(34 citation statements)

References 46 publications

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“…Eliciting history thoroughly gives complete information with regards to pain and a mnemonic described by Barnard et al “PQRST” aids this process where P stands for precipitating/alleviating factors, Q for quality of pain, R for radiation of pain, S for site and severity of pain, and T for timing/onset of pain, constant/intermittent pain . Various pain assessment tools such as Brief Pain Inventory, McGill Pain Questionnaire, Pain Management Index, and Edmonton Symptom Assessment System (ESAS) were used in ESRD patients in the past, however, Visual Analoge Scale (VAS) of modified ESAS was found to be valid in this patient population …”

Section: Pain Assessment In Esrdmentioning

confidence: 99%

“…Visual analog scale contains a vertical or horizontal line of 10 cm in length with “no pain” written at one end and “pain as bad as it could be” written at the other end . Patients are asked to draw a line perpendicular to VAS line that corresponds to their pain severity . The distance between “no pain” end to the perpendicular line measured and interpreted as no pain (0–0.4 cm), mild pain (0.5–4.4 cm), moderate pain (4.5–7.4 cm), and severe pain (7.5–10 cm) .…”

Section: Pain Assessment In Esrdmentioning

confidence: 99%

“…Extent of the pain relief is interpreted as “little relief” for 1 cm change on the VAS and “some relief” for 2 to 3 cm change on the VAS . VAS is a simple tool that can be used for rapid assessment, however, it does not distinguish between different types of pain and elderly patients may face difficulty understanding the scale …”

Section: Pain Assessment In Esrdmentioning

confidence: 99%

“…4 Various pain assessment tools such as Brief Pain Inventory, McGill Pain Questionnaire, Pain Management Index, and Edmonton Symptom Assessment System (ESAS) were used in ESRD patients in the past, however, Visual Analoge Scale (VAS) of modified ESAS was found to be valid in this patient population. [14][15][16] Visual analog scale contains a vertical or horizontal line of 10 cm in length with "no pain" written at one end and "pain as bad as it could be" written at the other end. 17 Patients are asked to draw a line perpendicular to VAS line that corresponds to their pain severity.…”

Section: Pain Assessment In Esrdmentioning

confidence: 99%

“…17 Patients are asked to draw a line perpendicular to VAS line that corresponds to their pain severity. 16,17 The distance between "no pain" end to the perpendicular line measured and interpreted as no pain (0-0.4 cm), mild pain (0.5-4.4 cm), moderate pain (4.5-7.4 cm), and severe pain (7.5-10 cm). 18 Extent of the pain relief is interpreted as "little relief" for 1 cm change on the VAS and "some relief" for 2 to 3 cm change on the VAS.…”

Section: Pain Assessment In Esrdmentioning

confidence: 99%

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Management of pain in end‐stage renal disease patients: Short review

Raina

Krishnappa

Gupta

2017

Hemodialysis International

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Pain management in end stage renal disease (ESRD) patients is a complex and challenging task to accomplish, and effective pain and symptom control improves quality of life. Pain is prevalent in more than 50% of hemodialysis patients and up to 75% of these patients are treated ineffectively due to its poor recognition by providers. A good history for PQRST factors and intensity assessment using visual analog scale are the initial steps in the management of pain followed by involvement of palliative care, patient and family counseling, discussion of treatment options, and correction of reversible causes. First line should be conservative management such as exercise, massage, heat/cold therapy, acupuncture, meditation, distraction, music therapy, and cognitive behavioral therapy. Analgesics are introduced according to WHO guidelines (by the mouth, by the clock, by the ladder, for the individual, and attention to detail) using three-step analgesic ladder model. Neuropathic pain can be controlled by gabapentin and pregabalin. Substitution/addition of opioid analgesics are indicated if pain control is not optimal. Commonly used opioids in ESRD patients are tramadol, oxycodone, hydromorphone, fentanyl, methadone, and buprenorphine. Methadone, fentanyl, and buprenorphine are the ideal analgesics in ESRD. However, complex pain syndrome requires multidrug analgesic regimen comprising opioids, non-opioids, and adjuvant medication, which should be individualized to the patient to achieve adequate pain control.

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Section: Pain Assessment In Esrdmentioning

confidence: 99%

Section: Pain Assessment In Esrdmentioning

confidence: 99%

Section: Pain Assessment In Esrdmentioning

confidence: 99%

Section: Pain Assessment In Esrdmentioning

confidence: 99%

Section: Pain Assessment In Esrdmentioning

confidence: 99%

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Management of pain in end‐stage renal disease patients: Short review

Raina

Krishnappa

Gupta

2017

Hemodialysis International

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Effect of Expedited Microneedle-Assisted Photodynamic Therapy for Field Treatment of Actinic Keratoses

et al. 2017

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IMPORTANCE Photodynamic therapy (PDT) is an effective and cosmetically favorable treatment modality for actinic keratoses (AKs). However, prolonged incubation times and pain associated with treatment are burdensome to the patient and a hindrance to widespread use of PDT as standard field therapy for AK. OBJECTIVE To evaluate efficacy and pain associated with microneedle expedited PDT. DESIGN, SETTING, AND PARTICIPANTS The Microneedle Photodynamic Therapy II (MNPDT-II) study was a randomized, single-blinded, split-face controlled, 2-arm clinical trial. Thirty-three participants with AK on the face were recruited in a university dermatology outpatient clinic from 2015 to 2016, and 32 participants completed the study. INTERVENTIONS Participants were randomized into 2 incubations arms, either 10-minute or 20-minute aminolevulinic acid (ALA) incubation times, after pretreatment with a microneedle roller (200 um) vs a sham roller. They were blinded to the laterality of microneedle and sham roller assignments. After incubation, they were exposed to blue light (Blu-U, Dusa Pharmaceuticals) for 1000 seconds for a total fluence of 10 J/cm 2. MAIN OUTCOMES AND MEASURES The primary outcome was to quantitatively measure AK resolution, and the secondary outcome was to assess pain associated with microneedle pretreatment. RESULTS Thirty-three individuals were recruited and randomized to either the 20-minute or the 10-minute incubation arm. Thirty-two participants completed the study with a mean follow-up time of 34.5 days in the 20-minute group, and 30.2 days in the 10-minute group. For the 20-minute incubation arm, average AK clearance was 76% vs 58% on the sham side (P < .01), including 3 patients with complete clearance, although not statistically significant (P = .25). Pain assessment on the visual analog scale (VAS) during blue light illumination was not significantly different between the microneedle and sham sides (0.7 and 0.4; P = .28), respectively. For the 10-minute incubation arm AK clearance for the microneedle pretreated side was 43% compared with 38% on the sham side (P = .66). Pain during the blue light exposure was not significantly different between the microneedle and sham sides, 4.5 mm and 3.4 mm (P = .21), respectively. CONCLUSIONS AND RELEVANCE Photodynamic therapy with microneedle pretreatment at a 20-minute ALA incubation time significantly improved AK clearance with efficacy similar to that of a conventional 1-hour ALA incubation time. The additional advantage to expedited treatment was that the procedure was virtually painless. However, expedited exposure of a 10-minute ALA incubation time did not reach significantly different AK clearance from the sham control. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02594644

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

et al. 2023

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ImportancePatients with end-stage kidney disease (ESKD) undergoing long-term hemodialysis often experience a high burden of debilitating symptoms for which effective treatment options are limited.ObjectiveTo compare the effectiveness of a stepped collaborative care intervention vs attention control for reducing fatigue, pain, and depression among patients with ESKD undergoing long-term hemodialysis.Design, Setting, and ParticipantsTechnology Assisted Stepped Collaborative Care (TĀCcare) was a parallel-group, single-blinded, randomized clinical trial of adult (≥18 years) patients undergoing long-term hemodialysis and experiencing clinically significant levels of fatigue, pain, and/or depression for which they were considering treatment. The trial took place in 2 US states (New Mexico and Pennsylvania) from March 1, 2018, to June 31, 2022. Data analyses were performed from July 1, 2022, to April 10, 2023.InterventionsThe intervention group received 12 weekly sessions of cognitive behavioral therapy delivered via telehealth in the hemodialysis unit or patient home, and/or pharmacotherapy using a stepped approach in collaboration with dialysis and primary care teams. The attention control group received 6 telehealth sessions of health education.Main Outcomes and MeasuresThe coprimary outcomes were changes in fatigue (measured using the Functional Assessment of Chronic Illness Therapy Fatigue), average pain severity (Brief Pain Inventory), and/or depression (Beck Depression Inventory-II) scores at 3 months. Patients were followed up for 12 months to assess maintenance of intervention effects.ResultsThere were 160 participants (mean [SD] age, 58 [14] years; 72 [45%] women and 88 [55%] men; 21 [13%] American Indian, 45 [28%] Black, 28 [18%] Hispanic, and 83 [52%] White individuals) randomized, 83 to the intervention and 77 to the control group. In the intention-to-treat analyses, when compared with controls, patients in the intervention group experienced statistically and clinically significant reductions in fatigue (mean difference [md], 2.81; 95% CI, 0.86 to 4.75; P = .01) and pain severity (md, −0.96; 95% CI, −1.70 to −0.23; P = .02) at 3 months. These effects were sustained at 6 months (md, 3.73; 95% CI, 0.87 to 6.60; P = .03; and BPI, −1.49; 95% CI, −2.58 to −0.40; P = .02). Improvement in depression at 3 months was statistically significant but small (md −1.73; 95% CI, −3.18 to −0.28; P = .02). Adverse events were similar in both groups.Conclusions and RelevanceThis randomized clinical trial found that a technology assisted stepped collaborative care intervention delivered during hemodialysis led to modest but clinically meaningful improvements in fatigue and pain at 3 months vs the control group, with effects sustained until 6 months.Trial RegistrationClinicalTrials.gov Identifier: NCT03440853

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Measuring pain in patients undergoing hemodialysis: a review of pain assessment tools

Cited by 34 publications

References 46 publications

Management of pain in end‐stage renal disease patients: Short review

Management of pain in end‐stage renal disease patients: Short review

Effect of Expedited Microneedle-Assisted Photodynamic Therapy for Field Treatment of Actinic Keratoses

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

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