Original investigation: dialysis therapy
Pain in hemodialysis patients: prevalence, cause, severity, and management

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Abstract

Background: There is growing evidence that dialysis patients have a high burden of symptoms, including pain. However, the prevalence, cause, severity, and management of pain in dialysis patients have not been described. Methods: This prospective cohort study of 205 Canadian hemodialysis (HD) patients describes the prevalence, cause, severity, and management of pain in this population. A chart review for demographic and clinical data was conducted, and patients completed a questionnaire that incorporated the Brief Pain Inventory, followed by the McGill Pain Questionnaire. Results: One hundred three patients (50%) reported a problem with pain. Patients with pain had been on HD therapy longer (52.2 months) than those without pain (37.7 months). Causes of pain were diverse, and 18.4% of patients had more than a single cause of their pain. Musculoskeletal pain was most common (50.5%) and equal in severity to pain associated with peripheral neuropathy and peripheral vascular disease. Fifty-five percent of patients with pain rated their worst episode in the previous 24 hours as severe. Thirty-two percent of patients with pain were administered no analgesics, 29.1% were administered nonopioid analgesics, 26.2% were administered weak opioids, and 9.7% were administered strong opioids. The Pain Management Index describes the effectiveness of pain management and was negative in 74.8% of patients, indicating ineffective management. Conclusion: Pain is a significant problem in more than 50% of HD patients and is not being effectively managed. The development of effective pain management strategies, underpinned by appropriate training and education, is necessary to improve the quality of life for dialysis patients.

Section snippets

Patient selection

This is a prospective cohort study of HD patients at the University of Alberta, Canada (2 in-center and 2 satellite HD units). The study was conducted between September 2001 and July 2002. All eligible patients were invited to participate. Eligibility criteria included age older than 18 years and the ability to converse and complete the questionnaires in English. Ethics approval was obtained from the University of Alberta Health Research Ethics Board, and written informed consent was obtained

Patient characteristics and prevalence of pain

There were 215 eligible patients. Two hundred five patients (81.7% response rate) were enrolled, and 46 patients refused participation. Patients refused because they did not wish to complete the questionnaire. Of these 46 patients, 18 patients (39%) were administered analgesics.

Patient characteristics are listed in Table 1. Study patients were mostly Caucasian (78.5%), with an average age of 60.0 ± 15.9 years. Fifty percent (n = 103) of patients reported a problem with pain. The only

Discussion

This study shows that pain is a common problem in HD patients. Fifty percent of HD patients in this study reported a problem with chronic pain, and 55% of these patients rated their pain as severe. Moreover, because 74.8% of patients had negative PMI scores, the study shows that pain management is suboptimal in patients undergoing long-term HD therapy.

The prevalence of chronic pain in the general population ranges from 2% to 45%.28, 29, 30, 31, 32 Variability in prevalence rates may be

Acknowledgements

The author thanks Judy Peng for help with administration of pain questionnaires and Gian Jhangri for statistical support and acknowledges the constructive suggestions provided by 3 anonymous reviewers.

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