Chronic Kidney Disease

Non-Opioid Recommendations For Pain Management in CKD Patients

A previously published review regarding pain management among patients with chronic kidney disease (CKD) with and without requirement for renal replacement therapy (RRT) has recently been updated.

Pain is common among patients with advanced and end-stage kidney disease (ESKD), affecting nearly 60% to 70% of those with the condition. Previous evidence has suggested that the pain is associated with depression and a lower quality of life in patients with kidney disease. A comprehensive pain assessment is important in forming appropriate treatment plans in these patients.
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Recommendations for pharmacologic treatment for CKD pain vary based on the severity of pain and disease:

  • Individuals with mild CKD may benefit from treatment with non-opioids with or without adjuvants, as well as nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, and acetaminophen.
  • Moderate CKD may be treated with non-opioids with or without adjuvants, and with or without weak opioids, including codeine, dihydrocodeine, hydrocodone, and tramadol.
  • Patients with severe CKD may be treated with non-opioids with or without adjuvants, and with or without moderate to strong opioids, including fentanyl, morphine, hydromorphone, methadone, levorphanol, and oxycodone. 
  • Patients with CKD may also benefit from topical analgesics for the management of acute and chronic pain.

The researchers noted that, when prescribing opioids, basic guidelines must be followed in order to avoid misuse and abuse.

The update also provides nonpharmacologic recommendations for pain management among patients with CKD who also have acute or subacute low back pain, chronic low back pain, or knee osteoarthritis.

“Similar to the general population, pain is a common problem among patients with pre-ESKD and those requiring RRT,” the researchers concluded. “Suboptimal pain control is associated with poor quality of life, depression and possibly long-term survival… Clinicians must master a basic understanding of both condition-specific and stepwise pain management and the pharmacokinetics of commonly prescribed analgesics/opioids to avoid severe adverse complications and abuse and dependence.”

—Christina Vogt

Reference:

Pham PC, Khaing K, Sievers TM, et al. 2017 update on pain management in patients with chronic kidney disease. Clin Kidney J. 2017;10(5):688-697. https://doi.org/10.1093/ckj/sfx080.