title: Pain Management in CKD: A Guide for Nephrology Providers.
abstract: Although pain is one of the most commonly experienced symptoms by patients with chronic kidney disease, it is under-recognized, the severity is underestimated, and the treatment is inadequate. Pain management is one of the general primary palliative care competencies for medical providers. This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Through this history, providers can identify clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis. Management of pain begins with the development of a shared treatment plan, identification of appropriate medications, and continual follow-up and assessment of efficacy and adverse effects. Through adequate pain management, providers can positively affect the health of individual patients and the performance of health care systems.
authors.affiliation: Division of Kidney Diseases & Hypertension, Hofstra-Northwell School of Medicine, Great Neck, NY. Electronic address: hkoncicki@northwell.edu.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Koncicki
authors.affiliation: Nephrology, New Mexico Veteran's Hospital, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, NM.
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
authors.affiliation: Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Jane O
authors.initials: JO
authors.lastname: Schell
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D009398:Nephrology; D059226:Nociceptive Pain / Q000209:etiology / Q000628:therapy; D010146:Pain / Q000209:etiology*; D059408:Pain Management; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000150:complications*
keywords: Pain; chronic kidney disease (CKD); end-stage renal disease (ESRD); neuropathic pain; nociceptive pain; opioids, analgesics, review; pain management; palliative care; quality of life