title: Treatment of pain in patients with renal insufficiency: the World Health Organization three-step ladder adapted.
abstract: The World Health Organization established official recommendations for managing pain in cancer patients. Since then, this stepladder approach has been widely adopted as a conceptual framework to treat all types of pain. However, those guidelines have not been critically evaluated for use in patients with renal insufficiency. In these patients, the questions of drug dosage adjustment and renal toxicity must be considered. This article reviews the pharmacokinetics of major analgesic drugs and data on their use and/or behavior in renal failure and considers their potential nephrotoxicity. Finally, according to available data in the international literature on pharmacokinetics, recommendations for dosage adjustment in patients with renal failure, and their potential nephrotoxicity, the World Health Organization three-step ladder for the treatment of pain was modified and adapted for patients with impaired renal function. Perspective This well-known treatment strategy now adapted for use in patients with renal insufficiency should secure and rationalize pain treatment in those patients.
authors.affiliation: Department of Nephrology, Pitie-Salpetriere Hospital, Paris, France. vincent.launay-vacher@psl.ap-hop-paris.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Launay-Vacher
authors.forename: Svetlana
authors.initials: S
authors.lastname: Karie
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Fau
authors.forename: Hassane
authors.initials: H
authors.lastname: Izzedine
authors.forename: Gilbert
authors.initials: G
authors.lastname: Deray
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D006801:Humans; D010146:Pain / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D051437:Renal Insufficiency / Q000150:complications*; D014944:World Health Organization
chemical_list: D000700:Analgesics