Pain Medicine.
Saint Francis Medical Center, Grand Island, Nebraska, USA.
Pain Med. 2017 Aug 1;18(8):1416-1449. doi: 10.1093/pm/pnw238.
To investigate the prevalence of chronic pain and opioid management among patients with chronic kidney disease (CKD).
Systematic review.
A systematic search was performed, including citations from 1960 to May 2015. The review highlights methodological quality assessment of the selected studies; prevalence of pain; type, dose, and reason for opioid use; effectiveness of pain control and associated adverse effects of opioids in CKD patients.
Twelve of 131 articles met inclusion criteria. There were no randomized controlled trials (RCT) evaluable, and 12 were observational studies. Out of 12 studies, four were of high quality, six were of moderate quality, and the remaining two were low-quality studies. The studies were from different countries with sample size ranging from 10 to 12,782. Several studies showed a high prevalence of chronic uncontrolled pain. The effectiveness of different categories of opioids, dose, duration, and commonly prescribed opioids varied across studies.
Based on a systematic review of the current literature, there is fair evidence for the high prevalence of chronic pain among patients with CKD, which is not being effectively managed, probably due to underprescription of analgesics or opioids in the CKD population. Clinicians are in need of additional and well-designed randomized control trials that focus on the indications for opioid therapy, appropriate opioid doses and dosing intervals, outcomes with adequacy of symptom control, and reporting on the incidence of adverse side effects.
调查慢性肾脏病（CKD）患者慢性疼痛和阿片类药物管理的流行情况。
系统评价。
进行了系统搜索，包括 1960 年至 2015 年 5 月的引文。本综述重点介绍了所选研究方法学质量评估、疼痛患病率、阿片类药物使用的类型、剂量和原因、CKD 患者疼痛控制的有效性以及阿片类药物相关不良反应。
131 篇文章中有 12 篇符合纳入标准。没有可评估的随机对照试验（RCT），其中 12 篇为观察性研究。在 12 项研究中，有 4 项为高质量研究，6 项为中等质量研究，其余 2 项为低质量研究。这些研究来自不同的国家，样本量从 10 到 12782 不等。几项研究表明，慢性未控制疼痛的患病率较高。不同类别的阿片类药物、剂量、持续时间和常用阿片类药物的有效性在研究中有所不同。
根据对当前文献的系统评价，CKD 患者慢性疼痛的患病率较高，但疼痛管理效果不佳，可能是由于 CKD 人群中镇痛剂或阿片类药物的处方不足。临床医生需要更多的、精心设计的随机对照试验，重点关注阿片类药物治疗的适应症、适当的阿片类药物剂量和给药间隔、症状控制充分的结果以及不良副作用的发生率报告。
