Dolati Sanam, Tarighat Faezeh, Pashazadeh Fariba, Shahsavarinia Kavous, Gholipouri Saina, Soleimanpour Hassan
Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Anesth Pain Med. 2020 Oct 20;10(5):e105754. doi: 10.5812/aapm.105754. eCollection 2020 Oct.
Chronic kidney disease (CKD) is a global public health problem. Pain is one of the most generally experienced symptoms by CKD patients. Pain management is a key clinical activity; nonetheless, insufficient pain management by health professionals keeps it up. Opioids as pain relievers are a class of naturally-derived and synthetic medications. They act through interactions with receptors in peripheral nerves. Numerous pharmacokinetic alterations happen with aging that influence drug disposition, metabolism, and quality of life. Acetaminophen alone, or combined with low-potency opioid dose is regarded as the safest pain-relieving choice for CKD. Morphine and codeine are probably eluded in renal impairment patients and used with excessive carefulness. Tramadol, oxycodone, and hydromorphone can be used by patient monitoring, while methadone, transdermal fentanyl, and buprenorphine seem to be safe to use in older non-dialysis patients with renal impairment. Consistent with the available literature, the main aim of this review was to explore the occurrence of chronic pain and its opioid treatment in CKD patients. According to this review, more and well-made randomized controlled trials are necessary to find appropriate opioid doses and explore the occurrence of side effects.
慢性肾脏病（CKD）是一个全球性的公共卫生问题。疼痛是CKD患者最常经历的症状之一。疼痛管理是一项关键的临床活动；尽管如此，医护人员对疼痛管理的不足仍持续存在。阿片类药物作为镇痛药是一类天然衍生和合成的药物。它们通过与外周神经中的受体相互作用发挥作用。随着年龄增长会发生许多药代动力学改变，这些改变会影响药物处置、代谢和生活质量。对CKD患者而言，单独使用对乙酰氨基酚或与低剂量低效阿片类药物联合使用被视为最安全的镇痛选择。肾功能损害患者可能应避免使用吗啡和可待因，使用时需格外谨慎。曲马多、羟考酮和氢吗啡酮可在患者监测下使用，而美沙酮、透皮芬太尼和丁丙诺啡在老年肾功能损害非透析患者中使用似乎是安全的。与现有文献一致，本综述的主要目的是探讨CKD患者慢性疼痛的发生情况及其阿片类药物治疗。根据本综述，需要更多设计良好的随机对照试验来确定合适的阿片类药物剂量并探究副作用的发生情况。
