The Present and Future of Pain Management in Patients With Chronic Kidney Disease: A Narrative Review

Area of Science:

• Nephrology
• Pain Medicine
• Pharmacology

Background:

• Chronic kidney disease (CKD) is a prevalent condition impacting patient quality of life, morbidity, and mortality.
• Over half of CKD patients suffer from chronic pain (nociceptive or neuropathic), complicating treatment due to altered drug metabolism and excretion.
• Physicians face challenges balancing analgesic safety and efficacy in CKD patients, often requiring dose reductions that may limit effectiveness.

Purpose of the Study:

• To review current pharmacological strategies for managing nociceptive and neuropathic pain in patients with chronic kidney disease.
• To explore emerging pain management alternatives, including cannabinoids and low-dose naltrexone.
• To summarize knowledge on anesthesia, perioperative, acute pain management, and injectable therapies like ketamine and corticosteroids in the context of CKD.

Main Methods:

• This is a narrative review.
• Literature search on pain management in CKD.
• Synthesis of information on established and novel analgesic approaches.

Main Results:

• Altered pharmacokinetics and pharmacodynamics in CKD necessitate individualized analgesic dosing.
• Established treatments for nociceptive and neuropathic pain require careful titration and monitoring.
• Emerging options like cannabinoids, low-dose naltrexone, ketamine, and corticosteroids offer potential but require further investigation in CKD.

Conclusions:

• Pain management in CKD must be individualized, with patient-physician discussion and close monitoring crucial for optimizing treatment.
• Balancing effective pain control with minimizing risks of adverse events is paramount in this vulnerable population.
• A comprehensive approach considering various pharmacological options and patient-specific factors is essential for successful pain management in CKD.