Pain in hemodialysis patients: prevalence, cause, severity, and management.
BACKGROUND
There is growing evidence that dialysis patients have a high burden of symptoms, including pain. However, the prevalence, cause, severity, and management of pain in dialysis patients have not been described.


METHODS
This prospective cohort study of 205 Canadian hemodialysis (HD) patients describes the prevalence, cause, severity, and management of pain in this population. A chart review for demographic and clinical data was conducted, and patients completed a questionnaire that incorporated the Brief Pain Inventory, followed by the McGill Pain Questionnaire.


RESULTS
One hundred three patients (50%) reported a problem with pain. Patients with pain had been on HD therapy longer (52.2 months) than those without pain (37.7 months). Causes of pain were diverse, and 18.4% of patients had more than a single cause of their pain. Musculoskeletal pain was most common (50.5%) and equal in severity to pain associated with peripheral neuropathy and peripheral vascular disease. Fifty-five percent of patients with pain rated their worst episode in the previous 24 hours as severe. Thirty-two percent of patients with pain were administered no analgesics, 29.1% were administered nonopioid analgesics, 26.2% were administered weak opioids, and 9.7% were administered strong opioids. The Pain Management Index describes the effectiveness of pain management and was negative in 74.8% of patients, indicating ineffective management.


CONCLUSIONS
Pain is a significant problem in more than 50% of HD patients and is not being effectively managed. The development of effective pain management strategies, underpinned by appropriate training and education, is necessary to improve the quality of life for dialysis patients.
Davison
Sara N
SN
Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada. sara.davison@ualberta.ca
D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D010523:Peripheral Nervous System Diseases / Q000150:complications; D016491:Peripheral Vascular Diseases / Q000150:complications; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid