Opioids for Chronic Pain Management in Patients with Dialysis-dependent Kidney Failure

Overview

Journal Nat Rev Nephrol

Specialty Nephrology

Date 2021 Oct 8

PMID 34621058

Citations 14

Authors

Daniel G Tobin

Mark B Lockwood

Paul L Kimmel

Laura M Dember

Nwamaka D Eneanya

Manisha Jhamb

Thomas D Nolin

William C Becker

Michael J Fischer

Affiliations

Soon will be listed here.

Abstract

Chronic pain is highly prevalent among adults treated with maintenance haemodialysis (HD) and has profound negative effects. Over four decades, research has demonstrated that 50-80% of adult patients treated with HD report having pain. Half of patients with HD-dependent kidney failure (HDKF) have chronic moderate-to-severe pain, which is similar to the burden of pain in patients with cancer. However, pain management in patients with HDKF is often ineffective as most patients report that their pain is inadequately treated. Opioid analgesics are prescribed more frequently for patients receiving HD than for individuals in the general population with chronic pain, and are associated with increased morbidity, mortality and health-care resource use. Furthermore, current opioid prescribing patterns are frequently inconsistent with guideline-recommended care. Evidence for the effectiveness of opioids in pain management in general, and in patients with HDKF specifically, is lacking. Nonetheless, long-term opioid therapy has a role in the treatment of some patients when used selectively, carefully and combined with an ongoing assessment of risks and benefits. Here, we provide a comprehensive overview of the use of opioid therapy in patients with HDKF and chronic pain, including a discussion of buprenorphine, which has potential as an analgesic option for patients receiving HD owing to its unique pharmacological properties.

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