Pain in end-stage renal disease: a frequent and neglected clinical problem

Abstract

Pain is a major health problem in end-stage renal disease (ESRD) affecting half of the dialysis patients; most of them experience a moderate to severe degree of pain. Nevertheless, the impact of chronic pain and its consequences are often underestimated. Sources of pain related to the uremic environment are renal bone disease (osteitis fibrosa cystica, amyloidosis, osteomalacia), osteoarthritis, calcific uremic arteriolopathy and peripheral neuropathy. Moreover, comorbid conditions such as ischemic peripheral artery disease, diabetic neuropathy, osteopenia/osteoporosis (due to long-standing hypertension, diabetes, or old age) result in various kinds of pain. Also the primary kidney disease (e.g. autosomal dominant polycystic kidney disease (ADPKD)) as well as performance of hemodialysis or peritoneal dialysis are important causes of pain. Potential consequences of persistent pain are disturbed sleep, weakened memory/attention, altered mood (anxiety and depressive disorder), impotence, poorer physical state, less social activities and consideration of withdrawal from dialysis. Consequently the health-related-quality of life (HRQOL) is diminished, associated with a higher morbidity and mortality. In the therapy of pain the WHO three-step analgesic ladder adapted for ESRD, was shown to be effective in dialysis patients. Of fundamental importance are various forms of non-pharmacological strategies including electrotherapy. Recently the so-called high tone external muscle stimulation (HTEMS) was very effective in the management of neuropathic pain in ESRD patients.

Low back pain in hemodialysis patients: Risk factors and its impact on health-related quality of life

“…[1] Low back pain (LBP) is also one of the major causes of musculoskeletal pain in hemodialysis patients. [2] As LBP is a common health problem, many individuals experience LBP at some point their lives. [3] It mostly originates from bones, intervertebral discs, joints, muscles, ligaments, neural structures, and blood vessels.…”

Associations of Depressive Symptoms and Pain with Dialysis Adherence, Health Resource Utilization, and Mortality in Patients Receiving Chronic Hemodialysis

“…Past studies demonstrate that depression and pain are present in approximately 20% and 50%, respectively, of patients receiving chronic hemodialysis, and both are strongly associated with impaired health-related quality of life. This has led to efforts to elucidate their associations with other adverse outcomes, including mortality (1,2,(7)(8)(9)(10)(11)(12)(13)(14). As part of the Dialysis Outcomes and Practice Patterns Study, Lopes et al demonstrated that among patients on chronic hemodialysis, depression was independently associated with increased mortality and hospitalization (15).…”

Enfermeiros atuantes em hemodiálise indicam diagnósticos de enfermagem relevantes na prática clínica

“…(20) Chronic and acute pain are common among hemodialysis patients, (2,12,13) with emphasis to bone pain, (13) abdominal pain, (21) pain during the hemodialysis access puncture, (22) osteoarthritis, uremic arteriolopathy and peripheral neuropathy. (23) The intensity of pain and discomfort among patients are important, interfering with quality of sleep and daily living. (24) Nausea, rated as a relevant diagnosis by the nurses, has been documented in hemodialysis patients.…”