Novel treatment protocol for ameliorating refractory, chronic pain in patients with autosomal dominant polycystic kidney disease.
Autosomal dominant polycystic kidney disease (ADPKD) patients can suffer from chronic pain that can be refractory to conventional treatment, resulting in a wish for nephrectomy. This study aimed to evaluate the effect of a multidisciplinary treatment protocol with sequential nerve blocks on pain relief in ADPKD patients with refractory chronic pain. As a first step a diagnostic, temporary celiac plexus block with local anesthetics was performed. If substantial pain relief was obtained, the assumption was that pain was relayed via the celiac plexus and major splanchnic nerves. When pain recurred, patients were then scheduled for a major splanchnic nerve block with radiofrequency ablation. In cases with no pain relief, it was assumed that pain was relayed via the aortico-renal plexus, and catheter-based renal denervation was performed. Sixty patients were referred, of which 44 were eligible. In 36 patients the diagnostic celiac plexus block resulted in substantial pain relief with a change in the median visual analogue scale (VAS) score pre-post intervention of 50/100. Of these patients, 23 received a major splanchnic nerve block because pain recurred, with a change in median VAS pre-post block of 53/100. In 8 patients without pain relief after the diagnostic block, renal denervation was performed in 5, with a borderline significant change in the median VAS pre-post intervention of 20/100. After a median follow-up of 12 months, 81.8% of the patients experienced a sustained improvement in pain intensity, indicating that our treatment protocol is effective in obtaining pain relief in ADPKD patients with refractory chronic pain.
Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Niek F
NF
Casteleijn
Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Maatje D A
MD
van Gastel
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands.
Peter J
PJ
Blankestijn
Department of Gastroenterology and Hepatology, Radboud Medical Center Nijmegen, University of Nijmegen, Nijmegen, Netherlands.
Joost P H
JP
Drenth
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands.
Rosa L
RL
de Jager
Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Anna M
AM
Leliveld
Pain Center, Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Ruud
R
Stellema
Pain Center, Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Andreas P
AP
Wolff
Pain Center, Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Gerbrand J
GJ
Groen
Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. Electronic address: R.T.Gansevoort@umcg.nl.
Ron T
RT
Gansevoort
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D017763:Autonomic Denervation / Q000009:adverse effects / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects; D002447:Celiac Plexus / Q000187:drug effects*; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications* / Q000175:diagnosis; D012008:Recurrence; D013153:Splanchnic Nerves / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
D000779:Anesthetics, Local
ADPKD; celiac plexus block; major splanchnic nerve block; pain; polycystic kidney disease; renal denervation