Lu Emily, Koncicki Holly M
Division of Nephrology, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of Nephrology, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Semin Nephrol. 2021 Jan;41(1):54-67. doi: 10.1016/j.semnephrol.2021.02.006.
Patients with chronic kidney disease (CKD) and end-stage renal disease experience high pain and symptom burden, but management of chronic pain in this population remains challenging. Recent studies have shown a high rate of opioid prescription and use in patients with kidney disease. However, the concern for opioid-related morbidity and mortality suggests a need to reconsider the safety and efficacy of opioid use in patients with CKD. In this review, we describe the current approaches to pain management in CKD, highlight the evolving opioid-related risks and kidney-specific concerns, and offer both pharmacologic and nonpharmacologic nonopioid strategies for pain management in patients with kidney disease, emphasizing the importance of using a multimodal approach to optimize pain control.
慢性肾脏病（CKD）和终末期肾病患者承受着高度的疼痛和症状负担，但对这一人群的慢性疼痛管理仍然具有挑战性。最近的研究表明，肾病患者中阿片类药物的处方率和使用率很高。然而，对阿片类药物相关发病率和死亡率的担忧表明，有必要重新考虑在CKD患者中使用阿片类药物的安全性和有效性。在这篇综述中，我们描述了CKD患者疼痛管理的当前方法，强调了不断演变的阿片类药物相关风险和肾脏特异性问题，并为肾病患者提供了疼痛管理的药物和非药物非阿片类策略，强调了采用多模式方法优化疼痛控制的重要性。
