Most patients with chronic kidney disease may experience long-term pain

Because chronic pain in patients with chronic kidney disease (CKD) is not fully understood, Jeffrey Fink, MD, MS, Juliana Wu, BS (University of Maryland School of Medicine), and their colleagues examined information on pain and pain medication use in 308 pre-dialysis CKD patients enrolled between 2011 and 2013 in the Safe Kidney Care cohort study in Baltimore.

The majority of patients (60.7%) reported chronic pain. More severe pain was reported by patients with arthritis, those taking 12 or more medications, and those with reduced physical function. As expected, increased pain was linked with intensified use of pain medications, but this was often accompanied by the use of ill-advised medications for patients with kidney problems or the use of medications that were dosed improperly.

"We demonstrated that there is a link between pain and patient safety in CKD and that the CKD population warrants closer attention to their pain management such that practitioners can avert clinically significant adverse safety events," said Dr. Fink.

In an accompanying editorial, Sara Davison, MD, MHSc (University of Alberta, in Canada) noted that the work is an important step in understanding the patterns of pain medication use and misuse in patients with CKD. "The effectiveness of chronic analgesic use for chronic pain is essentially unexplored in CKD and further research is urgently required to guide clinical decisions on the basis of evidence," she wrote. "We need to be able to identify patients who may benefit from long-term analgesic use and patients who may be particularly vulnerable to possible analgesic-related harms."