Navigating pain in chronic kidney disease: Overcoming inertia!

Despite being one of the most common symptoms in patients with chronic kidney disease (CKD), pain management in this population is challenging for healthcare professionals. We conducted a cross-sectional survey of 60 practicing Tunisian primary care physicians who agreed to complete a questionnaire developed using Google Forms and distributed via social media and specialized online pages over a two-week period. It revealed that 71% encountered difficulties initiating pain treatment for CKD patients due to knowledge gaps, fear of side effects, and limited access to nephrologists. Many doctors avoided prescribing maximum paracetamol doses, while 90% refrained from using NSAIDs due to concerns about long-term effects. For higher-level analgesics, 71% didn’t reach recommended doses due to fear of side effects. 55% didn’t seek a nephrologist’s opinion, with 39% deeming it unnecessary. One in four didn’t consult a specialist due to workload and location challenges. Our study provides novel insights by identifying, in the Tunisian context, the practical and cognitive determinants of this therapeutic inertia, an aspect that has been scarcely explored in the literature. It highlights the need for targeted strategies to improve clinical practice.