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      2017 update on pain management in patients with chronic kidney disease

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          Abstract

          The prevalence of pain has been reported to be >60–70% among patients with advanced and end-stage kidney disease. Although the underlying etiologies of pain may vary, pain per se has been linked to lower quality of life and depression. The latter is of great concern given its known association with reduced survival among patients with end-stage kidney disease. We herein discuss and update the management of pain in patients with chronic kidney disease with and without requirement for renal replacement therapy with the focus on optimizing pain control while minimizing therapy-induced complications.

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          Most cited references49

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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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              A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain.

              Between 40% and 60% of Americans use complementary and alternative medicine to manage medical conditions, prevent disease, and promote health and well-being. Omega-3 polyunsaturated fatty acids (omega-3 PUFAs) have been used to treat joint pain associated with several inflammatory conditions. We conducted a meta-analysis of 17 randomized, controlled trials assessing the pain relieving effects of omega-3 PUFAs in patients with rheumatoid arthritis or joint pain secondary to inflammatory bowel disease and dysmenorrhea. Meta-analysis was conducted with Cochrane Review Manager 4.2.8. for six separate outcomes using standardized mean differences (SMDs) as a measure of effect size: (1) patient assessed pain, (2) physician assessed pain, (3) duration of morning stiffness, (4) number of painful and/or tender joints, (5) Ritchie articular index, and (6) nonselective nonsteroidal anti-inflammatory drug consumption. Supplementation with omega-3 PUFAs for 3-4 months reduces patient reported joint pain intensity (SMD: -0.26; 95% CI: -0.49 to -0.03, p=0.03), minutes of morning stiffness (SMD: -0.43; 95% CI: -0.72 to -0.15, p=0.003), number of painful and/or tender joints (SMD: -0.29; 95% CI: -0.48 to -0.10, p=0.003), and NSAID consumption (SMD: -0.40; 95% CI: -0.72 to -0.08, p=0.01). Significant effects were not detected for physician assessed pain (SMD: -0.14; 95% CI: -0.49 to 0.22, p=0.45) or Ritchie articular index (SMD: 0.15; 95% CI: -0.19 to 0.49, p=0.40) at 3-4 months. The results suggest that omega-3 PUFAs are an attractive adjunctive treatment for joint pain associated with rheumatoid arthritis, inflammatory bowel disease, and dysmenorrhea.
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                Author and article information

                Journal
                Clin Kidney J
                Clin Kidney J
                ckj
                Clinical Kidney Journal
                Oxford University Press
                2048-8505
                2048-8513
                October 2017
                18 August 2017
                18 August 2017
                : 10
                : 5
                : 688-697
                Affiliations
                [1 ]Division of Nephrology and Hypertension, Olive View-UCLA Medical Center, Sylmar, CA, USA
                [2 ]Division of Nephrology, Kidney Transplantation, Ronald Reagan Medical Center at UCLA, Los Angeles, CA, USA
                [3 ]Department of Medicine, Veterans Administrations Greater Los Angeles Healthcare System, Los Angeles, CA, USA
                [4 ]Division of Hematology and Oncology, Olive View-UCLA Medical Center, Sylmar, CA, USA
                [5 ]Division of Cardiovascular Diseases, Audie L Murphy Memorial Veterans Hospital, San Antonio, TX, USA
                [6 ]Division of Cardiovascular Diseases, Veterans Administration Nebraska–Western Iowa Healthcare System, Omaha, NE, USA
                Author notes
                Correspondence and offprint requests to: Phuong Chi Pham; E-mail: Pham.PC@ 123456ucla.edu
                Article
                sfx080
                10.1093/ckj/sfx080
                5622905
                28979781
                ded2d680-1ded-444d-8405-f24323e9a703
                © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA.

                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

                History
                : 03 May 2017
                : 19 June 2017
                Page count
                Pages: 10
                Categories
                Advanced CKD

                Nephrology
                ckd, ,dialysis, ,kidney transplantation, ,nsaids, ,opioids, ,pain
                Nephrology
                ckd, , dialysis, , kidney transplantation, , nsaids, , opioids, , pain

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