Department of Behavioral Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, IL.
Center for Excellence in Behavioral Medicine, Department of Surgery, University of Pittsburg, Pittsburg, PA.
Semin Nephrol. 2021 Nov;41(6):550-562. doi: 10.1016/j.semnephrol.2021.10.007.
Patient reports of moderate to severe pain are common across the spectrum of chronic kidney disease. The synergistic effects of comorbid depression and anxiety can lead to maladaptive coping responses to pain, namely pain catastrophizing and illness-related post-traumatic stress disorder. If underlying depression and anxiety and associated maladaptive coping responses are not treated, patients can experience an increased perception of pain, worsened disability, decreased quality of life, withdrawal from social activities, and increased morbidity and mortality. Meanwhile, interest in nonpharmacologic treatments for pain that targets coping as well as comorbid anxiety and depression has been increasing, particularly given the significant societal damage that has resulted from the opioid epidemic. Evidence-based, nonpharmacologic treatments have shown promise in treating pain in areas outside of nephrology. Currently, little is known about the effects of these treatments among adults with CKD, and particularly end-stage kidney disease, when chronic pain can become debilitating. In this review, we examine patient-centered concepts related to pain that have received little attention in the nephrology literature. We also describe emerging areas of research, including omics technologies for biomarker discovery and advanced symptom clustering methods for symptom phenotyping, which may be useful to future kidney disease research and treatment.
患者报告在慢性肾脏病的各个阶段都有中度至重度疼痛。共病性抑郁和焦虑的协同作用可能导致对疼痛的适应不良应对反应，即疼痛灾难化和与疾病相关的创伤后应激障碍。如果未治疗潜在的抑郁和焦虑以及相关的适应不良应对反应，患者可能会经历疼痛感知增加、残疾加重、生活质量下降、回避社会活动以及发病率和死亡率增加。与此同时，针对应对以及共病性焦虑和抑郁的非药物治疗疼痛的兴趣也在增加，尤其是考虑到阿片类药物流行造成的重大社会损害。循证非药物治疗在肾脏病学以外的领域治疗疼痛方面显示出了希望。目前，人们对慢性肾脏病患者（尤其是终末期肾病患者）中这些治疗方法的效果知之甚少，因为慢性疼痛可能会使人致残。在这篇综述中，我们检查了在肾脏病学文献中很少受到关注的与疼痛相关的以患者为中心的概念。我们还描述了新出现的研究领域，包括用于生物标志物发现的组学技术和用于症状表型的先进症状聚类方法，这些可能对未来的肾脏病研究和治疗有用。
