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American Journal of Kidney Diseases

Pain Management in CKD: A Guide for Nephrology Providers

Published:November 20, 2016DOI:https://doi.org/10.1053/j.ajkd.2016.08.039
      Although pain is one of the most commonly experienced symptoms by patients with chronic kidney disease, it is under-recognized, the severity is underestimated, and the treatment is inadequate. Pain management is one of the general primary palliative care competencies for medical providers. This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Through this history, providers can identify clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis. Management of pain begins with the development of a shared treatment plan, identification of appropriate medications, and continual follow-up and assessment of efficacy and adverse effects. Through adequate pain management, providers can positively affect the health of individual patients and the performance of health care systems.

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      Linked Article

      • Opioid Overuse or NSAID Underuse? A Response to the Pain Guide
        American Journal of Kidney DiseasesVol. 69Issue 6
        • Preview
          Koncicki and colleagues1 offer a timely guide to pain management in chronic kidney disease (CKD). However, it relies heavily on the World Health Organization (WHO) pain ladder (originally created to guide the treatment of cancer pain), with the major adaptation to avoid nonsteroidal anti-inflammatory drugs (NSAIDs). The recent Centers for Disease Control and Prevention (CDC) guideline with its emphasis on avoiding opioids for chronic pain would have been a safer resource.
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