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      Pain management in patients with chronic kidney disease

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          Abstract

          Pain has been reported to be a common problem in the general population and end-stage renal disease (ESRD) patients. Although similar data for pre-ESRD patients are lacking, we recently reported that the prevalence of pain is also very high (>70%) among pre-ESRD patients at a Los Angeles County tertiary referral centre. The high prevalence of pain in the CKD population is particularly concerning because pain has been shown to be associated with poor quality of life. Of greater concern, poor quality of life, at least in dialysis patients, has been shown to be associated with poor survival. We herein discuss the pathophysiology of common pain conditions, review a commonly accepted approach to the management of pain in the general population, and discuss analgesic-induced renal complications and therapeutic issues specific for patients with reduced renal function.

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          Most cited references 59

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          The prevalence of symptoms in end-stage renal disease: a systematic review.

          Symptoms in end-stage renal disease (ESRD) are underrecognized. Prevalence studies have focused on single symptoms rather than on the whole range of symptoms experienced. This systematic review aimed to describe prevalence of all symptoms, to better understand total symptom burden. Extensive database, "gray literature," and hand searches were undertaken, by predefined protocol, for studies reporting symptom prevalence in ESRD populations on dialysis, discontinuing dialysis, or without dialysis. Prevalence data were extracted, study quality assessed by use of established criteria, and studies contrasted/combined to show weighted mean prevalence and range. Fifty-nine studies in dialysis patients, one in patients discontinuing dialysis, and none in patients without dialysis met the inclusion criteria. For the following symptoms, weighted mean prevalence (and range) were fatigue/tiredness 71% (12% to 97%), pruritus 55% (10% to 77%), constipation 53% (8% to 57%), anorexia 49% (25% to 61%), pain 47% (8% to 82%), sleep disturbance 44% (20% to 83%), anxiety 38% (12% to 52%), dyspnea 35% (11% to 55%), nausea 33% (15% to 48%), restless legs 30% (8%to 52%), and depression 27% (5%to 58%). Prevalence variations related to differences in symptom definition, period of prevalence, and level of severity reported. ESRD patients on dialysis experience multiple symptoms, with pain, fatigue, pruritus, and constipation in more than 1 in 2 patients. In patients discontinuing dialysis, evidence is more limited, but it suggests they too have significant symptom burden. No evidence is available on symptom prevalence in ESRD patients managed conservatively (without dialysis). The need for greater recognition of and research into symptom prevalence and causes, and interventions to alleviate them, is urgent.
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            Pain in children: comparison of assessment scales.

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              Pain: moving from symptom control toward mechanism-specific pharmacologic management.

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                Author and article information

                Journal
                NDT Plus
                NDT Plus
                ckj
                ndtplus
                NDT Plus
                Oxford University Press
                1753-0784
                1753-0792
                April 2009
                30 January 2009
                30 January 2009
                : 2
                : 2
                : 111-118
                Affiliations
                [1 ]Nephrology Division, Department of Medicine, Olive View-UCLA Medical Center, Sylmar
                [2 ]Department of Medicine, Greater Los Angeles VA Medical Center, Los Angeles
                [3 ]Mercy General Hospital , Sacramento
                [4 ]Cardiology Division, Good Samaritan Hospital/Harbor-UCLA Medical Center, Los Angeles
                [5 ]David Geffen School of Medicine at UCLA, Kidney and Pancreas Transplant Program, Los Angeles, CA, USA
                Author notes
                Correspondence and offprint requests to: Phuong-Chi T. Pham, Department of Medicine, Nephrology Division, Olive View-UCLA Medical Center, 14445 Olive View Drive, 2B-182, Sylmar, CA 91342, USA. Tel: +1-818-364-3205; Fax: +1-818-364-4573; E-mail: pham.pc@ 123456ucla.edu
                Article
                sfp001
                10.1093/ndtplus/sfp001
                4421348
                25949305
                © The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                Categories
                In-Depth Clinical Review

                Nephrology

                analgesics, chronic kidney disease, nsaids, opioids, pain

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