, Volume 78, Issue 14, pp 1459–1479 | Cite as

Assessing and Treating Chronic Pain in Patients with End-Stage Renal Disease

  • Flaminia ColuzziEmail author
Review Article


Pain is one of the most common symptoms among patients with end-stage renal disease (ESRD), and is often under recognized and not adequately managed in hemodialysis (HD) patients. Barriers to adequate pain management include poor awareness of the problem, insufficient medical education, fears of possible drug-related side effects, and common misconceptions about the inevitability of pain in elderly and HD patients. Caregivers working in HD should be aware of the possible consequences of inadequate pain assessment and management. Common pain syndromes in HD patients include musculoskeletal diseases and metabolic neuropathies, associated with typical intradialytic pain. Evaluating the etiology, nature, and intensity of pain is crucial for choosing the correct analgesic. A mechanism-based approach to pain management may result in a better outcome. Pharmacokinetic considerations on clearance alterations and possible toxicity in patients with ESRD should drive the right analgesic prescription. Comorbidities and polymedications may increase the risk of drug–drug interactions, therefore drug metabolism should be taken into account when selecting analgesic drugs. Automedication is common among HD patients but should be avoided to reduce the risk of hazardous drug administration. Further research is warranted to define the efficacy and safety of analgesic drugs and techniques in the context of patients with ESRD as generalizing information from studies conducted in the general population could be inappropriate and potentially dangerous. A multidisciplinary approach is recommended for the management of complex pain syndromes in frail patients, such as those suffering from ESRD.


Compliance with Ethical Standards


No funding was received for the preparation or publication of this manuscript.

Conflict of interest

Flaminia Coluzzi has no conflicts of interest to declare.


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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Medical and Surgical Sciences and BiotechnologiesSapienza University of Rome, Polo PontinoLatinaItaly

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