Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Semin Dial. 2020 May;33(3):286-296. doi: 10.1111/sdi.12881. Epub 2020 May 4.
Pain is one of the most common symptoms reported by patients with end-stage kidney disease (ESKD) and negatively impacts their health-related quality of life (HRQOL), dialysis adherence, healthcare utilization, and mortality. There are a number of patient-related and health system-related barriers that make it very challenging to treat pain in these patients. Moreover, the limited availability of efficacious and safe nonopiate analgesic options has led to over-use of opioids in this population. We propose a framework for pain assessment and tailored treatment using nonpharmacological and pharmacological approaches to optimize pain management and opioid use. Additionally, we recommend system-level changes to improve care coordination and pain management in ESKD patients.
疼痛是终末期肾病（ESKD）患者最常见的症状之一，对他们的健康相关生活质量（HRQOL）、透析依从性、医疗保健利用和死亡率产生负面影响。有许多与患者相关和与卫生系统相关的障碍，使得治疗这些患者的疼痛极具挑战性。此外，有效的、安全的非阿片类镇痛药选择有限，导致该人群中阿片类药物的过度使用。我们提出了一个使用非药物和药物方法进行疼痛评估和针对性治疗的框架，以优化疼痛管理和阿片类药物的使用。此外，我们建议进行系统层面的改变，以改善 ESKD 患者的护理协调和疼痛管理。
