Chronic Pain & Kidney Disease—More Study Needed

Chronic Pain & Kidney Disease—More Study Needed

Female Scientific Research Team With Clear Solution In LaboratorA common theme in recent reporting by the National Pain Report has been the lack of research devoted to chronic pain issues.

While a study in the Clinical Journal of the American Society of Nephrology highlights chronic pain from early stage chronic kidney disease (CKD) and what it calls “the inappropriate use of pain medications”, buried in the press release was this nugget.

More research is needed.

“Given the prevalence of chronic pain and analgesic use in CKD patients, greater attention should be given to devising optimal pain management strategies as a means to improve medication safety and effectively address the health needs of this population,” said lead study author Jeffrey Fink, MD, from the Department of Medicine, University of Maryland School, Baltimore.

An accompanying editorial by Sara Davison, MD, professor, Department of Medicine, University of Alberta, Edmonton, Canada, supports these conclusions. “Currently little is known about the use and safety of analgesics, including opioids, in CKD and the impact of analgesic use on clinically relevant outcomes such as analgesic effect, [health-related quality of life], physical function or adverse events is essentially unexplored,” she notes.

“This work (the research) is an important step in understanding the patterns of analgesic use and misuse [in CKD],” Dr Davison writes.

Pain control in CKD should be handled with a comprehensive approach that includes physical, psychological, and behavioral therapies, according to Dr Davison. Further research on the effectiveness of analgesics for chronic pain in CKD is also needed.

What did the study show?

“We demonstrated that there is a link between pain and patient safety in CKD and that the CKD population warrants closer attention to their pain management such that practitioners can avert clinically significant adverse safety events,” added Dr. Fink.

Although chronic pain is common in end-stage renal disease, less is known about pain in pre-dialysis CKD, and safety may be an issue. Some prescription and over-the-counter analgesics require renal dosing. In addition, non-steroidal anti-inflammatory medications (NSAIDs) are nephrotoxic but may be frequently used for pain in CKD, the authors note.

 

Dr Fink and colleagues analyzed data from 308 pre-dialysis patients enrolled between 2011 and 2013 in the Safe Kidney Care cohort in Baltimore, Maryland. They assessed pain and analgesic use over the course of 12 months, using self-reported questionnaires. Analgesics were categorized as “drug-related problems” on the basis of their potential for nephrotoxicity and whether the dose was appropriate to the participants’ estimated glomerular filtration rate. NSAIDs were considered drug-related problems regardless of estimated glomerular filtration rate.

 

Analyses revealed the following statistics.:

 

  • 7% of participants reported chronic pain,
  • 72% of them had pain three to four times per week
  • Patients with arthritis were more likely to report severe pain as were patients taking 12 or more medications
  • Patients aged 65 years and older had lower odds of reporting severe pain

 

Across the population, the adjusted per patient rate for use of an analgesics with a drug-related problem increased with increasing pain. In addition the likelihood a patient would use an analgesic with a drug-related problem increased as pain increased. Specifically, patients with mild chronic pain were more than three times as likely to receive an inappropriate analgesic.

 

Participants most commonly used acetaminophen (34%), tramadol (15%), strong opioids (12%), NSAIDs (5%), and codeine (3%). Ibuprofen was the most commonly used NSAID.

 

Authored by: Ed Coghlan

There are 4 comments for this article
  1. Stephen S. Rodrigues, MD at 5:16 pm

    This article is about the tertiary problems resulting from dismantling the full forced old-school traditional medicine. I blame a few men in the AMA who created this hungry beast. So everything that is being realized today in healthcare can be traced back to a mission that was contrived more than 50 years ago. These few men created our present hungry beast which is devouring resources, destroying lives, killing people, causing many to go bankrupt and is taking up more and more of our GDP.

    These few men in the AMA, decided that chiropractors were curing a lot of the pain and arthritis patients keeping them out of the operating rooms. So they devised a plan that chiropractors were not scientific enough and they were wacky, quacky, greedy and dangerous. It worked and is still working to fuel this chaos.

    Chiropractors who use their hands and leverage to unlock the pain of everyday life were a vital part of controlling healthcare costs and saving lives. Without them we are left with pills and the most expensive way to treat pain and that is in the operating room.

    Chiropractic medicine was the essence of the artistry of medicine so without it one is left only with the science-based aspects of medicine. Today science-based medicine is not really science-based, it’s more like science fiction-based because it has no reality basis.

    I imagine these few men then decided to remove other aspects which would effectively treat the pain of muscles and connective tissue to further their profits. So they removed other old-school physical therapy departments, anything that had to do with holistic and restorative treatments like acupuncture, dry and wet needling, GunnIMS, Travell/Simon’s trigger point injections and even the idea of preventive care of the body. So without these old-schooled connections, we are left to treat pain with lies, flawed logic, pills and surgery.

    Little did these few men know that long-term pain starts and breeds within muscles and connective tissue. So if left untreated, will slowly degrade muscle functions. Muscles do more than just locomotion, muscle help to process many metabolic functions ie hormones, BP, blood sugar, medications, regulate pH etc. So, muscle dysfunction is the breeding soil for the demon, the devil or Lucifer == So called dense complex pain, stubborn migraines, TN, neuropathy, centralization, RSD/CRPS etc. This is the pain and misery which is like a living medieval torture. This MF dysfunction has the ability to grow and spread like a cancer. It will not go away all by itself, it requires intensive treatments just like any other deadly cancer.

    As I promote alternatives and advocate for pain therapy, I see no light at the end of the tunnel. In my opinion the private sector will do nothing to change. The government will have to jump in with the national guard. Without the reestablishment of old-school traditional medicine, healthcare will continue being a death trap.

  2. LouisVA at 9:48 am

    To all chronic pain patients:

    We now have an opportunity to voice our concerns re opioid medication access. Congress is working on a couple of bills and YOUR VOICE MATTERS!

    Please contact your Senators and Representatives in the U.S. Congress and ask them to support the pending bills titled “Ensuring Patient Access and Effective Drug Enforcement Act of 2015″. Bills have been introduced in both the Senate and the House. The Senate version is S. 483; the House bill is H.R. 471. If passed, this legislation will require the Secretary of HHS and Administrator of the DEA to submit a report to Congress assessing how drug enforcement activities impact patient access to pain care. Specifically, the report will identify (1) obstacles to legitimate patient access to controlled substances; (2) issues with diversion of controlled substances; and (3) how collaboration between Federal, State, local, and tribal law enforcement agencies and the pharmaceutical industry can benefit patients and prevent diversion and abuse of controlled substances. The legislation would require participation of patient advocates, doctors, drug companies, pharmacists, insurance companies – all types of stakeholders – in the fact-finding and development of this report.

    The National Fibromyalgia and Chronic Pain Association (NFMCPA), a group of which I am a member, considers this a strong bill to support the chronic pain patient perspective. Patient advocacy groups will have the opportunity to provide input and recommendations as the report to Congress is developed. This is exactly the kind of action we need to help chronic pain patients have access to better pain care and the pain medications they need. Please help us by speaking out now.

    Members of Congress generally provide on their websites a means to submit your comments online, or you can call or write a letter. Commenting online is easy to do – just as quick and easy as buying something on Amazon. One short paragraph submitted online is all it takes to make your voice heard! Be sure to include the title of the bill. You can find contact info for your senators and representative in Congress at the following links:

    http://www.senate.gov/general/contact_information/senators_cfm.cfm

    http://www.house.gov/representatives/find/

    You can read the text of the pending bills at the following links:

    http://www.hatch.senate.gov/public/_cache/files/5b4c2d56-105f-41bf-afaf-6291a3225eac/Ensuring%20Patient%20Access%20and%20Effective%20Drug%20Enforcement%20Act%20of%202015%5B1%5D.pdf

    https://www.opencongress.org/bill/hr471-114/show

    This notice was prepared by Louis Ogden, patient of Dr. Forest Tennant, and Kristen Ogden, patient family member, who are working as volunteer advocates with the NFMCPA.

  3. Ryan Lankford at 2:34 pm

    Ugh. The opiophobic docs who cared for my mother as she passed away from renal failure refused to give her adequate pain relief because they were worried about “the effects that opioids may have on her kidneys.” HELLO, SHE IS DYING IN HOSPICE!

  4. LouisVA at 2:15 pm

    It seems to be the consensus for most every condition that results in pain “the inappropriate use of pain medications” is the result. Why is there so much bias against opioids? In the case of renal disease, of course one would be unwise to use analgesics such as Percocet or hydrocodone due to the Tylenol in these products. A lot of opioids are pure and would not result in additional damage. I have centralized pain as a result of many, many years of fibromyalgia (another disease that opioids should not be used for according to many). I am 65 years old and thanks to opioids the last 4 years has been the highest quality of life I’ve had as an adult. In fact, I could not stand the pain level without these meds. The decision to use opioids should be a personal one between a doctor and patient. These blanket statements that are made against opioids are not helpful to millions of people in pain; they are simply statements made by physicians that are biased against their use. What a tragedy!!!!!