Skip to main content
SpringerLink
Log in

Pain Management in Patients with Renal Impairment

  • Chapter
Pain Management and Palliative Care

  • 3163 Accesses

Abstract

Patients with chronic kidney disease must be given extra consideration when prescribing medications for symptom control as many medications are excreted through the renal system. Renal function, or glomerular filtration rate, should be estimated by calculating creatinine clearance using the Cockcroft–Gault equation. Patients with CKD are often excluded from trials, and for many medications specific studies regarding dosing and metabolism in this population are lacking. Therefore, it is important to note recommendations, use caution when starting medications, and follow patients closely.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ADH:

Antidiuretic hormone

CHF:

Congestive heart failure

C max :

Concentration max/peak concentration

CNS:

Central nervous system

CrCl:

Creatinine clearance

CSF:

Cerebral spinal fluid

ESRD:

End stage renal disease

GFR:

Glomerular filtration rate

HD:

Hemodialysis

IBW:

Ideal body weight

M6G:

Morphine-6-glucuronide

NSAID:

Nonsteroidal anti-inflammatory drugs

PD:

Peritoneal dialysis

SIADH:

Syndrome of inappropriate antidiuretic hormone secretion

SNRI:

Serotonin–norepinephrine reuptake inhibitors

SSRIs:

Selective serotonin reuptake inhibitors

t 1/2 :

Half-life

TCA:

Tricyclic antidepressants

Vd:

Volume of distribution

References

  1. Barakzoy AS, Moss AH. Efficacy of the world health organization analgesic ladder to treat pain in end-stage renal disease. J Am Soc Nephrol. 2003;17:3198–203.

    Article  Google Scholar 

  2. Davison SN. Pain in hemodialysis patients: prevalence, cause, severity, and management. Am J Kidney Dis. 2003;42:1239–47.

    Article  PubMed  Google Scholar 

  3. Food and Drug Administration. Guidance for Industry: Pharmacokinetics in patients with impaired renal function—study design, data analysis and impact on dosing and labeling. Rockville: Department of Health and Human Services; 1998.

    Google Scholar 

  4. Taal M, Chertow G, Marsden P, Skorecki K, Yu A, Brenner B. Brenner & Rector’s The kidney. 9th ed. Elsevier Inc: Philadelphia; 2012.

    Google Scholar 

  5. Aronoff GR, Bennett WM, Berns JS, Brier ME, Kasbekar N, Mueller BA, Pasko DA, Smoyer WE. Drug prescribing in renal failure: dosing guidelines for adults and children. 5th ed. Philadelphia: American College of Physicians; 2007.

    Google Scholar 

  6. Henrich WL, Agodoa LE, Barrett B, Bennett WM, Blantz RC, Buckalew VM, D’Agati VD, DeBroe ME, Duggin GG, Eknoyan G, Elseviers MM, Gomez A, Matzke GR, Porter GA, Sabatini S, Stoff JS, Striker GE, Winchester JF. Analgesics and the kidney: summary and recommendations to the scientific advisory board of the National Kidney Foundation from an ad hoc committee of the National Kidney Foundation. Am J Kidney Dis. 1996;27:162–5.

    Article  CAS  PubMed  Google Scholar 

  7. Kurella M, Bennet WM, Chertow GM. Analgesia in patients with ESRD: a review of available evidence. Am J Kidney Dis. 2003;42:217–28.

    Article  CAS  PubMed  Google Scholar 

  8. Whelton A. Nephrotoxicity of nonsteroidal anti-inflammatory drugs: physiologic foundations and clinical implications. Am J Med. 1999;106:S13–24.

    Article  Google Scholar 

  9. Johnson AG, Nguyen TV, Day RO. Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis. Ann Intern Med. 1994;121:289–300.

    Article  CAS  PubMed  Google Scholar 

  10. Pope JE, Anderson JJ, Felson DT. A meta-analysis of the effects of nonsteroidal anti-inflammatory drugs on blood pressure. Arch Intern Med. 1993;153:477–84.

    Article  CAS  PubMed  Google Scholar 

  11. Lidoderm [package insert]. Endo Pharmaceuticals Inc., Chadds Ford. 2010. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=18476. Accessed 2 Jan 2013.

  12. Andrews PA, Sampson SA. Topical non-steroid drugs are systemically absorbed and may cause renal disease. Nephrol Dial Transplant. 1999;14:187–9.

    Article  CAS  PubMed  Google Scholar 

  13. Flector [package insert]. Teikoku Seiyaku Co. Ltd., Sanbonmatsu. 2004. http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021234lbl.pdf. Accessed 2 Jan 2013.

  14. Desipramine HCl [package insert]. Sandoz Inc, Princeton. 2011. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=7ec5f73f-32b6-48c3-b16e-891d06edf6eb. Accessed 30 Oct 2012.

  15. Naylor HK, Raymond CB. Treatment of neuropathic pain in patients with chronic kidney disease. CAANT J. 2011;21:34–9.

    Google Scholar 

  16. Unterecker S, Müller P, Jacob C, Riederer P, Pfuhlmann B. Therapeutic drug monitoring of antidepressants in haemodialysis patients. Clin Drug Investig. 2012;32:539–45.

    CAS  PubMed  Google Scholar 

  17. Venlafaxine [package insert]. Wyeth, Philadelphia. 2004. http://www.accessdata.fda.gov/drugsatfda_docs/label/2004/20151slr028,030,032,20699slr041,048,052_effexor_lbl.pdf. Accessed 24 Sept 2012.

  18. Lobo ED, Heathman M, Kuan HY, Reddy S, O’Brien L, Gonzales C, Skinner M, Knadler MP. Effects of varying degrees of renal insufficiency on the pharmacokinetics of duloxetine. Analysis of a single-dose phase I study and pooled steady state data from phase II/III trials. Clin Pharmacokinet. 2010;49:311–21.

    Article  CAS  PubMed  Google Scholar 

  19. Puozzo C, Pozet N, Deprez D, Baille P, Ung HL, Zech P. Pharmacokinetics of milnacipran in renal impairment. Eur J Drug Metab Pharmacokinet. 1998;23:280–6.

    Article  CAS  PubMed  Google Scholar 

  20. Savella (milnacipran HCl) [package insert]. Forest Pharmaceuticals Inc. 2009. http://www.frx.com/products/savella.aspx. Accessed 30 Oct 2012.

  21. Dogukan A, Aygen B, Berilgen MS, Dag S. Gabapentin-induced coma in a patient with renal failure. Hemodial Int. 2006;10:168–9.

    Article  PubMed  Google Scholar 

  22. Bookwalter T, Gitlin M. Gabapentin-induced neurologic toxicities. Pharmacotherapy. 2005;25:1817–9.

    Article  PubMed  Google Scholar 

  23. Neurontin [US physician prescribing information]. Pfizer distributed by Parke-Davis, New York. 2012. http://labeling.pfizer.com/ShowLabeling.aspx?id=630. Accessed 17 Sept 2012.

  24. Yoo L, Matalon D, Hoffman RS, Goldfarb DS. Treatment of pregabalin toxicity by hemodialysis in a patient with kidney failure. Am J Kidney Dis. 2009;54:1127–30.

    Article  PubMed  Google Scholar 

  25. Murphy N, Mockler M, Ryder M, Ledwidge M, McDonald K. Decompensation of chronic heart failure associated with pregabalin in patients with neuropathic pain. J Card Fail. 2007;13:227–9.

    Article  PubMed  Google Scholar 

  26. Page II RL, Cantu M, Lindenfeld J, Hergott LJ, Lowes BD. Possible heart failure exacerbation associated with pregabalin: case discussion and literature review. J Cardiovasc Med. 2008;9:922–5.

    Article  Google Scholar 

  27. De Smedt RH, Jaarsma T, van der Broek SA, Haaijer-Ruskamp FM. Decompensation of chronic heart failure associated with pregabalin in a 73-year-old patient with postherpetic neuralgia: a case report. Br J Clin Pharmacol. 2008;66:327–8.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Lyrica [full prescribing information]. Pfizer distributed by Parke-Davis, New York. 2012. http://labeling.pfizer.com/ShowLabeling.aspx?id=561. Accessed 17 Sept 2012.

  29. Topamax [Prescribing Information]. Janseen Ortho LLC, Curabo. 2009. http://www.topamax.com/sites/default/files/topamax.pdf. Accessed 3 Mar 2013.

  30. Izzedine H, Launay-Vacher V, Deray G. Topiramate-induced renal tubular acidosis. Am J Med. 2004;116:281–2.

    Article  CAS  PubMed  Google Scholar 

  31. Fernández-de OL, Esteban-Fernández J, Aichner HF, Casillas-Villamor Á, Rodriguez-Álvarez S. Topiramate-induced metabolic acidosis: a case study. Nefrologia. 2013;32:403–4.

    Google Scholar 

  32. Sacré A, Jouret F, Manicourt D, Devuyst O. Topiramate induces type 3 renal tubular acidosis by inhibiting renal carbonic anhydrase. Nephrol Dial Transplant. 2006;21:2995–6.

    Article  PubMed  Google Scholar 

  33. Mirza N, Marson A, Pirmohamed M. Effect of topiramate on acid-base balance: extent, mechanism and effects. Br J Clin Pharmacol. 2009;68:655–61.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Lamb EJ, Stevens PE, Nashef L. Topiramate increased biochemical risk of nephrolithiasis. Ann Clin Biochem. 2004;41:166–9.

    Article  PubMed  Google Scholar 

  35. Prabahar MR, Karthik KR, Sing M, Singh RB, Singh S, Dhamodharan J. Successful treatment of carbamezapine poisoning with hemodialysis: a case report and review of the literature. Hemodial Int. 2011;15:407–11.

    Article  Google Scholar 

  36. Carbamazepine [package insert]. Distributed by Novartis Pharmaceuticals Corporation, East Hanover. 2012. http://www.pharma.us.novartis.com/product/pi/pdf/tegretol.pdf. Accessed 2 Nov 2012.

  37. Pilapil M, Petersen J. Efficacy of hemodialysis and charcoal hemoperfusion in carbamazepine overdose. Clin Toxicol. 2008;46:342–3.

    Article  CAS  Google Scholar 

  38. Skelaxin [package insert]. Corepharma LLC, Middlesex. 2011. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=51427. Accessed 26 Sept 2012.

  39. Tizanidine [package insert]. Dr. Reddy’s Laboratories Limited, Bachepalli. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=16397. Accessed 25 Sept 2012.

  40. Kitabata Y, Orita H, Kamimura M, Shiizaki K, Narukawa N, Abe T, Kobata H, Akizawa T. Symptomatic bradycardia probably due to tizanidine hydrochloride in a chronic hemodialysis patient. Ther Apher Dial. 2005;9:74–7.

    Article  PubMed  Google Scholar 

  41. Sica DA, Comstock TJ, Davis J, Manning L, Powell R, Melikian A, Wright G. Pharmacokinetics and protein binding of methocarbamol in renal insufficiency and normals. Eur J Clin Pharmacol. 1990;39:193–4.

    Article  CAS  PubMed  Google Scholar 

  42. Robaxin [package insert]. Schwarz Pharma LLC, Smynra. 2009. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=38053#nlm34068-7. Accessed 25 Sept 2012.

  43. Chlorzoxazone [package insert]. Watson Pharma Private Limited, Verna, Salcette Goa. 2010. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=52547#nlm34068-7. Accessed 2 Jan 2013.

  44. Flexeril [product insert]. Merck & Co. Inc, West Point. 2001. http://www.accessdata.fda.gov/drugsatfda_docs/label/2003/017821s045lbl.pdf. Accessed 25 Sept 2012.

  45. Spiller HA, Winter ML, Mann KV, Borys DJ, Muir S, Krenzelok EP. Five-year multicenter retrospective review of cyclobenzaprine toxicity. J Emerg Med. 1995;13:781–5.

    Article  CAS  PubMed  Google Scholar 

  46. Brvar M, Vrtovec M, Kovač D, Pezdir T, Bunc M. Haemodialysis clearance of baclofen. Eur J Clin Pharmacol. 2007;63:1143–6.

    Article  PubMed  Google Scholar 

  47. El-Husseini A, Sabucedo A, Lamarche J, Courville C, Peguero A. Baclofen toxicity in patients with advanced nephropathy: proposal for new labeling. Am J Nephrol. 2011;34:491–5.

    Article  CAS  PubMed  Google Scholar 

  48. Chen YC, Chang CT, Fang JT, Huang CC. Baclofen neurotoxicity in uremic patients: is continuous ambulatory peritoneal dialysis less effective than intermittent hemodialysis? Ren Fail. 2003;25:297–305.

    Article  CAS  PubMed  Google Scholar 

  49. Chou CL, Chen CA, Lin SH, Huang HH. Baclofen-induced neurotoxicity in chronic renal failure patients with intractable hiccups. South Med J. 2006;99:1308–9.

    Article  PubMed  Google Scholar 

  50. Stoddart JC, Parkin JM, Wynee NA. Orphenadrine poisoning. A case report. Brit J Anaesth. 1968;40:789–90.

    Article  CAS  PubMed  Google Scholar 

  51. Hespe W, de Roos AM, Nauta WT. Investigation into the metabolic fate of orphenadrine hydrochloride after oral administration to male rats. Arch Int Pharmacodyn Ther. 1965;156:180–200.

    CAS  PubMed  Google Scholar 

  52. Mao YC, Hung DZ, Yang CC, Wang JD. Full recovery from a potentially lethal dose of orphenadrine ingestion using conservative treatment: a case report. Hum Exp Toxicol. 2010;29:961–3.

    Article  PubMed  Google Scholar 

  53. Garza MB, Osterhoudt KC, Rutstein R. Central anticholinergic syndrome from orphenadrine in a 3 year old. Pediatr Emerg Care. 2000;16:97–8.

    Article  CAS  PubMed  Google Scholar 

  54. Carisoprodol [package insert]. Vintage Pharmaceuticals Inc, Charlotte. 2010. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=22442. Accessed 25 Sept 2012.

  55. Serfer GT, Wheeler WJ, Sacks HJ. Randomized, double-blind trial of carisoprodol 250 mg compared with placebo and carisoprodol 350 mg for the treatment of low back spasm. Curr Med Res Opin. 2010;26:91–9.

    Article  CAS  PubMed  Google Scholar 

  56. Ultram (tramadol hydrochloride) [full prescribing information]. Janssen Ortho LLC, Guarabo. 2008. http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020281s032s033lbl.pdf. Accessed 24 Sept 2012.

  57. Gardner JS, Blough D, Drinkard CR, Shantin D, Anderson G, Graham D, Alderfer R. Tramadol and seizures: a surveillance study in a managed care population. Pharmacotherapy. 2000;20:1423–31.

    Article  CAS  PubMed  Google Scholar 

  58. Barnung SK, Treschow M, Borgbjerg FM. Respiratory depression following oral tramadol in a patient with impaired renal function. Pain. 1997;71:111–2.

    Article  CAS  PubMed  Google Scholar 

  59. Stamer UM, Stüber F, Muders T, Musshoff F. Respiratory depression with tramadol in a patient with renal impairment and CYP2D6 gene duplication. Anesth Analg. 2008;107:926–9.

    Article  PubMed  Google Scholar 

  60. Durotram XR [product information]. iNova Pharmaceuticals, Thornleigh. 2008. http://www.medsafe.govt.nz/profs/datasheet/d/durotramxrtab.pdf. Accessed 17 Sept 2012.

  61. Guay DR, Awni WM, Findlay JW, Halstenson CE, Abraham PA, Opsahl JA, Jones EC, Matzke GR. Pharmacokinetics and pharmacodynamics of codeine in end-stage renal disease. Clin Pharmacol Ther. 1988;43:63–71.

    Article  CAS  PubMed  Google Scholar 

  62. Murtagh FE, Chai MO, Donohoe P, Edmonds PM, Higginson IJ. The use of opioid analgesia in end-stage renal disease patients managed without dialysis: recommendations for practice. J Pain Palliat Care Pharmacother. 2007;21:5–16.

    PubMed  Google Scholar 

  63. Talbott GA, Lynn AM, Levy FH, Zelikovic I. Respiratory arrest precipitated by codeine in a child with chronic renal failure. Clin Pediatr. 1997;36:171–3.

    Article  CAS  Google Scholar 

  64. Dean M. Opioids in renal failure and dialysis patients. J Pain Symptom Manage. 2004;28:497–504.

    Article  CAS  PubMed  Google Scholar 

  65. D’Honneur G, Gilton A, Sandouk P, Scherrmann JM, Duvaldestin P. Plasma and cerebrospinal fluid concentrations of morphine and morphine glucuronides after oral morphine. The influence of renal failure. Anesthesiology. 1994;81:87–93.

    Article  PubMed  Google Scholar 

  66. Bodd E, Jacobsen D, Lund E, Ripel Å, Mørland J, Wiik-Larsen E. Morphine-6-glucuronide might mediate the prolonged opioid effect of morphine in acute renal failure. Hum Exp Toxicol. 1990;9:317–21.

    Article  CAS  PubMed  Google Scholar 

  67. Angst MS, Bührer M, Lötsch J. Insidious intoxication after morphine treatment in renal failure: delayed onset of morphine-6-glucoronide action. Anesthesiology. 2000;92:1473–6.

    Article  CAS  PubMed  Google Scholar 

  68. Lagas JS, Wagenaar JF, Huitema AD, Hillebrand MJ, Koks CH, Gerdes VE, Brandjes DP, Beijnen JH. Lethal morphine intoxication in a patient with sickle cell crisis and renal impairment: case report and a review of the literature. Hum Exp Toxicol. 2011;30:1399–403.

    Article  CAS  PubMed  Google Scholar 

  69. Bunn R, Ashley C. The renal drug handbook. Oxford: Radcliffe Medical Press; 1999.

    Google Scholar 

  70. Vicodin (Hydrocodone Bitartrate and Acetaminophen) [package insert]. Abott Laboratories, North Chicago. 2011. http://www.rxabbott.com/pdf/vicodin.pdf. Accessed 30 Oct 2012.

  71. Terlinden R, Ossig J, Fliegert F, Lange C, Göhler K. Absorption, metabolism, and excretion of 14C-labeled tapentadol HCl in healthy male subjects. Eur J Drug Metab Pharmacokinet. 2007;32:163–9.

    Article  CAS  PubMed  Google Scholar 

  72. Hartick C. Tapentadol immediate-release for acute pain. Expert Rev Neurother. 2010;10:861–9.

    Article  Google Scholar 

  73. Nucynta (tapentadol) [package insert]. Ortho-McNeil-Janssen Pharmaceuticals Inc, Raritan. 2010. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=07c33315-90c9-4a73-bf1d-bca70c7e0ff5. Accessed 30 Oct 2012.

  74. Vorsanger G, Xiang J, Biondi D, Upmalis D, Delfgaauw J, Allard R, Moskovitz B. Post hoc analyses of data from a 90-day clinical trial evaluating the tolerability and efficacy of tapentadol immediate release and oxycodone immediate release for the relief of moderate to severe pain in elderly and nonelderly patients. Pain Res Manag. 2011;16:245–51.

    PubMed Central  PubMed  Google Scholar 

  75. Mercadante S, Porzio G, Ferrera P, Aielli F, Adile C, Ficorella C, Giarratano A, Casuccio A. Tapentadol in cancer pain management: a prospective open-label study. Curr Med Res Opin. 2012;28:1–5.

    Article  Google Scholar 

  76. Lugo RA, Kern SE. The pharmacokinetics of oxycodone. J Pain Palliat Care Pharmacother. 2004;18:17–30.

    Article  PubMed  Google Scholar 

  77. Foral PA, Ineck JR, Nystrom KK. Oxycodone accumulation in a hemodialysis patient. South Med J. 2007;100:212–4.

    Article  PubMed  Google Scholar 

  78. Broadbent A, Khor K, Heaney A. Palliation and chronic renal failure: opioid and other palliative medications—dosage guidelines. Prog in Palliat Care. 2003;11:183–90.

    Article  Google Scholar 

  79. Dilaudid [Package Insert]. Abbott Laboratories, North Chicago. 2007. http://medlibrary.org/lib/rx/meds/dilaudid/. Accessed 18 Sept 2012.

  80. Durnin C, Hind ID, Wickens MM, Yates DB, Molz KH. Pharmacokinetics of oral immediate-release hydromorphone (Dilaudid® IR) in subjects with renal impairment. Proc West Pharmacol Soc. 2001;44:81–2.

    CAS  PubMed  Google Scholar 

  81. Paramanandam G, Prommer E, Schwenke DC. Adverse effects in hospice patients with chronic kidney disease receiving hydromorphone. J Palliat Med. 2011;14:1029–33.

    Article  PubMed  Google Scholar 

  82. Lee MA, Leng ME, Tiernan EJ. Retrospective study of the use of hydromorphone in palliative care patients with normal and abnormal urea and creatinine. Palliat Med. 2001;15:26–34.

    Article  CAS  PubMed  Google Scholar 

  83. Kreek MJ, Schecter AJ, Gutjahr CL, Hect M. Methadone use in patients with chronic renal disease. Drug Alcohol Depend. 1980;5:197–205.

    Article  CAS  PubMed  Google Scholar 

  84. Furlan V, Hafi A, Dessalles MC, Bouchez J, Charpentier B, Taburet AM. Methadone is poorly removed by haemdialysis. Nephrol Dial Transplant. 1999;14:254.

    Article  CAS  PubMed  Google Scholar 

  85. Karanikolas M, Aretha D, Kiekkas P, Monantera G, Tsolakis I, Filos KS. Intravenous fentanyl patient-controlled analgesia for perioperative treatment of neuropathic/ischaemic pain in haemodialysis patients: a case series. J Clin Pharm Ther. 2010;35:603–8.

    Article  CAS  PubMed  Google Scholar 

  86. Szeto HH, Inturrisi CE, Houde R, Saal S, Cheigh J, Reidenberg MM. Accumulation of normeperidine, an active metabolite of meperidine, in patients with renal failure or cancer. Ann Intern Med. 1977;86:738–41.

    Article  CAS  PubMed  Google Scholar 

  87. Kaiko RF, Foley KM, Gabinski PY, Heidrich G, Rogers AG, Inturrisi CE, Reidenberg MM. Central nervous system excitatory effects of meperidine in cancer patients. Ann Neurol. 1983;13:180–5.

    Article  CAS  PubMed  Google Scholar 

  88. Miller RR, Jick H. Clinical effects of meperidine in hospitalized medical patients. J Clin Pharmacol. 1978;18:180–9.

    Article  CAS  PubMed  Google Scholar 

  89. Hassan H, Bastani B, Gellens M. Successful treatment of normeperidine neurotoxicity by hemodialysis. Am J Kidney Dis. 2000;35:146–9.

    Article  CAS  PubMed  Google Scholar 

  90. Hochman MS. Meperidine-associated myoclonus and seizures in long-term hemodialysis patients. Ann Neurol. 1983;14:593.

    Article  CAS  PubMed  Google Scholar 

  91. Butrans patch [package insert]. LTS Lohmann Therapie-Systeme AG, Andernach. 2010. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=65886. Accessed 2 Jan 2013.

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Kidney Diseases and Hypertension, Hofstra North Shore-LIJ School of Medicine, Great Neck, NY, USA

    Holly M. Koncicki M.D., M.S.

Authors
  1. Holly M. Koncicki M.D., M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Holly M. Koncicki M.D., M.S. .

Editor information

Editors and Affiliations

  1. Department of Rehabilitation Medicine, Interventional Pain Management, New York University , Langone Medical Center, New York, New York, USA

    Kimberly A. Sackheim

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Koncicki, H.M. (2015). Pain Management in Patients with Renal Impairment. In: Sackheim, K. (eds) Pain Management and Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2462-2_30

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2462-2_30

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2461-5

  • Online ISBN: 978-1-4939-2462-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation