Davison Sara N
Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada.
Am J Kidney Dis. 2003 Dec;42(6):1239-47. doi: 10.1053/j.ajkd.2003.08.025.
There is growing evidence that dialysis patients have a high burden of symptoms, including pain. However, the prevalence, cause, severity, and management of pain in dialysis patients have not been described.
This prospective cohort study of 205 Canadian hemodialysis (HD) patients describes the prevalence, cause, severity, and management of pain in this population. A chart review for demographic and clinical data was conducted, and patients completed a questionnaire that incorporated the Brief Pain Inventory, followed by the McGill Pain Questionnaire.
One hundred three patients (50%) reported a problem with pain. Patients with pain had been on HD therapy longer (52.2 months) than those without pain (37.7 months). Causes of pain were diverse, and 18.4% of patients had more than a single cause of their pain. Musculoskeletal pain was most common (50.5%) and equal in severity to pain associated with peripheral neuropathy and peripheral vascular disease. Fifty-five percent of patients with pain rated their worst episode in the previous 24 hours as severe. Thirty-two percent of patients with pain were administered no analgesics, 29.1% were administered nonopioid analgesics, 26.2% were administered weak opioids, and 9.7% were administered strong opioids. The Pain Management Index describes the effectiveness of pain management and was negative in 74.8% of patients, indicating ineffective management.
Pain is a significant problem in more than 50% of HD patients and is not being effectively managed. The development of effective pain management strategies, underpinned by appropriate training and education, is necessary to improve the quality of life for dialysis patients.
越来越多的证据表明，透析患者承受着包括疼痛在内的多种症状的沉重负担。然而，透析患者疼痛的患病率、病因、严重程度及管理情况尚未得到描述。
这项对205名加拿大血液透析（HD）患者的前瞻性队列研究描述了该人群疼痛的患病率、病因、严重程度及管理情况。进行了病历回顾以获取人口统计学和临床数据，患者完成了一份包含简明疼痛问卷的调查问卷，随后是麦吉尔疼痛问卷。
103名患者（50%）报告有疼痛问题。有疼痛的患者接受HD治疗的时间（52.2个月）比无疼痛的患者（37.7个月）更长。疼痛原因多种多样，18.4%的患者有不止一种疼痛原因。肌肉骨骼疼痛最为常见（50.5%），其严重程度与周围神经病变和周围血管疾病相关的疼痛相当。55%有疼痛的患者将其在前24小时内最严重的发作评为重度。32%有疼痛的患者未接受任何镇痛药治疗，29.1%接受了非阿片类镇痛药治疗，26.2%接受了弱阿片类镇痛药治疗，9.7%接受了强阿片类镇痛药治疗。疼痛管理指数描述了疼痛管理的有效性，74.8%的患者该指数为负，表明管理无效。
超过50%的HD患者存在疼痛这一重大问题，且未得到有效管理。在适当的培训和教育支持下制定有效的疼痛管理策略，对于提高透析患者的生活质量是必要的。
