title: Chronic pain and analgesic use in CKD: implications for patient safety.
abstract: OBJECTIVE
  Chronic pain in predialysis CKD is not fully understood. This study examined chronic pain in CKD and its relationship with analgesic usage.
  
  
  METHODS
  Data include baseline visits from 308 patients with CKD enrolled between 2011 and 2013 in the Safe Kidney Care cohort study in Baltimore, Maryland. The Wong-Baker FACES Pain Rating Scale measured chronic pain severity. Analgesic prescriptions and over-the-counter purchases were recorded up to 30 days before visits, and were classified as a drug-related problem (DRP) based on an analgesic's nephrotoxicity and dose appropriateness at participants' eGFR. Participants were sorted by pain frequency and severity and categorized into ordinal groups. Analgesic use and the rate of analgesics with a DRP were reported across pain groups. Multivariate regression determined the factors associated with chronic pain and assessed the relationship between chronic pain and analgesic usage.
  
  
  RESULTS
  There were 187 (60.7%) participants who reported chronic pain. Factors associated with pain severity included arthritis, taking ≥12 medications, and lower physical function. Use of nonsteroidal anti-inflammatory drugs was reported by seven participants (5.8%) with no chronic pain. Mild and severe chronic pain were associated with analgesics with a DRP, with odds ratios of 3.04 (95% confidence interval [95% CI], 1.12 to 8.29) and 5.46 (95% CI, 1.85 to 16.10), respectively. The adjusted rate of analgesics with a DRP per participant increased from the group with none to severe chronic pain, with rates of 0.07 (95% CI, 0.04 to 0.13), 0.12 (95% CI, 0.07 to 0.20) and 0.16 (95% CI, 0.09 to 0.27), respectively.
  
  
  CONCLUSIONS
  Chronic pain is common in CKD with a significant relationship between the severity of pain and both proper and improper analgesic usage. Screening for chronic pain may help in understanding the role of DRPs in the delivery of safe CKD care.
authors.affiliation: Departments of Medicine and.
authors.forename: Juliana
authors.initials: J
authors.lastname: Wu
authors.affiliation: Departments of Medicine and.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Ginsberg
authors.affiliation: Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; and.
authors.forename: Min
authors.initials: M
authors.lastname: Zhan
authors.affiliation: Departments of Medicine and.
authors.forename: Clarissa J
authors.initials: CJ
authors.lastname: Diamantidis
authors.affiliation: Departments of Medicine and.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore.
authors.forename: Corinne
authors.initials: C
authors.lastname: Woods
authors.affiliation: Departments of Medicine and jfink@medicine.umaryland.edu.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Fink
mesh_terms: D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D001168:Arthritis / Q000150:complications / Q000188:drug therapy; D059350:Chronic Pain / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D057970:Inappropriate Prescribing; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D061214:Patient Safety; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D012651:Self Medication
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: CKD; analgesics; pain; patient safety