An Approach to Pain Management in End Stage Renal Disease: Considerations for General Management and Intradialytic Symptoms

2015 ◽  
Vol 28 (4) ◽  
pp. 384-391 ◽  
Author(s):  
Holly M. Koncicki ◽  
Frank Brennan ◽  
Katie Vinen ◽  
Sara N. Davison
Keyword(s):  
Pain Management ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
General Management ◽  
Stage Renal Disease ◽  
End Stage ◽  
Intradialytic Symptoms

scholarly journals Pain management in patients with end-stage renal disease and calciphylaxis- a survey of clinical practices among physicians

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Rajkumar Chinnadurai ◽  
Smeeta Sinha ◽  
Aoife C Lowney ◽  
Mary Miller
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Pain Management ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Palliative Medicine ◽  
Current Practice ◽  
Care Planning ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline. Methods An online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options. Results One hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time. Conclusion There was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.

scholarly journals Pain management in patients with end-stage renal disease and calciphylaxis- A survey among physicians and clinical practice recommendations

2020 ◽  
Author(s):  
Rajkumar Chinnadurai ◽  
Smeeta Sinha ◽  
Aoife Lowney ◽  
Mary Miller
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Pain Management ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Palliative Medicine ◽  
Current Practice ◽  
Care Planning ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline.Methods An online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options. Results One hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time.Conclusion There was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.

scholarly journals Pain management in patients with end-stage renal disease and calciphylaxis- A survey among physicians and clinical practice recommendations

2020 ◽  
Author(s):  
Rajkumar Chinnadurai ◽  
Smeeta Sinha ◽  
Aoife Lowney ◽  
Mary Miller
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Pain Management ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Palliative Medicine ◽  
Current Practice ◽  
Care Planning ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline.MethodsAn online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options. ResultsOne hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time.ConclusionThere was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.

Sign in / Sign up

Export Citation Format

Share Document