Geertsema Paul, Gansevoort Ron T, Doornweerd Benjamin H J, de Haas Robbert J, Perdok Joke M, Roemeling Stijn, Stellema Ruud, Wolff André P, Casteleijn Niek F
Department of Nephrology, Expertise Center for Polycystic Diseases, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
Department of Urology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
J Clin Med. 2025 Aug 8;14(16):5623. doi: 10.3390/jcm14165623.
: Kidney-related pain can be chronic, disabling and negatively impact quality of life. In this prospective case series, we assessed whether a stepwise multidisciplinary treatment protocol, originally developed to treat ADPKD-related pain, can provide significant pain relief in non-ADPKD patients with kidney-related pain. Patients were eligible if they had incapacitating kidney-related pain with a visual analogue scale (VAS) score ≥50 out of 100, lasting ≥3 months and with insufficient response to previous treatments. The main exclusion criterion was ADPKD. Treatment options were, in order when indicated, nonpharmacological treatments, analgesics, cyst aspiration and fenestration, nerve blocks and nephrectomy. The effect of treatment on pain was investigated by means of VAS scores, defined daily dose of pain medication and quality-of-life scores. Twelve patients (67% female, median age 50 [IQR: 36-59] years), with a median duration of pain of 1.9 [1.0-4.7] years, were included. In 50% of cases, chronic pain remained after an acute episode of kidney stones. Median follow-up after treatment was 3.8 [IQR: 2.5-4.4] years. The VAS before treatment (70 (48-90)) was reduced at short-term (35 [28-53], = 0.01) and long-term follow-up (40 [38-53], = 0.01). In addition, the defined daily dose of both opioids and non-opioids was reduced at short-term follow-up ( = 0.04 and 0.04, respectively) as well as at long-term follow-up ( = 0.03 and = 0.02, respectively). We found that our multidisciplinary treatment protocol is effective in achieving sustained pain relief as well as a reduction in the use of pain medication in non-ADPKD patients with chronic, refractory kidney-related pain.
与肾脏相关的疼痛可能是慢性的、使人丧失能力的，并对生活质量产生负面影响。在这个前瞻性病例系列中，我们评估了最初为治疗常染色体显性多囊肾病（ADPKD）相关疼痛而制定的逐步多学科治疗方案，是否能为患有与肾脏相关疼痛的非ADPKD患者提供显著的疼痛缓解。如果患者有使人丧失能力的与肾脏相关的疼痛，视觉模拟量表（VAS）评分≥100分中的50分，持续≥3个月且对先前治疗反应不足，则符合入选标准。主要排除标准是ADPKD。治疗选择按指示顺序依次为非药物治疗、镇痛药、囊肿抽吸和开窗术、神经阻滞和肾切除术。通过VAS评分、每日规定的止痛药剂量和生活质量评分来研究治疗对疼痛的影响。纳入了12名患者（67%为女性，中位年龄50岁[四分位间距：36 - 59岁]），疼痛中位持续时间为1.9年[1.0 - 4.7年]。在50%的病例中，肾结石急性发作后仍存在慢性疼痛。治疗后的中位随访时间为3.8年[四分位间距：2.5 - 4.4年]。治疗前的VAS（70（48 - 90））在短期随访时降低（35[28 - 53]，P = 0.01），在长期随访时也降低（40[38 - 53]，P = 0.01）。此外，阿片类药物和非阿片类药物的每日规定剂量在短期随访时均降低（分别为P = 0.04和0.04），在长期随访时也降低（分别为P = 0.03和P = 0.02）。我们发现，我们的多学科治疗方案对于患有慢性、难治性与肾脏相关疼痛的非ADPKD患者，在实现持续疼痛缓解以及减少止痛药使用方面是有效的。
