Pain is something everyone experiences to different degrees, but for many people with chronic kidney disease (CKD), pain can be unrelenting and unbearable. To address this symptom of CKD, the American Kidney Fund (AKF) hosted a pain management webinar with Dr. Randy Chen, a nephrologist with Satellite Healthcare. In the webinar, Dr. Chen explained the different types of pain, why CKD patients experience pain, and what treatment options are available to manage it.*

Why do we have pain? 

Nearly 60% of people on hemodialysis report having moderate or severe chronic pain. Dr. Chen explains that pain occurs as a way of your body communicating to you that something is not right. 

• Your body may signal acute, or short-term, pain when triggered by something, but it typically goes away quickly. An example of this is touching a hot stove. 
• Chronic, or long-term, pain is usually a result of constant nerve stimulation with injury or inflammation of the nerve. Diabetic neuropathy and arthritis are common chronic pains.  

What are the common causes of pain in CKD? 

Over time, poor kidney function may lead to one, or more than one, of the following painful conditions:

• Neuropathy
• Gout
• Metabolic bone disease

In dialysis, pain can also be caused by:

• Needle insertion into dialysis access
• Inflammation caused by the dialysis process  

Why should I treat my pain?

Many people ignore or dismiss their pain because it can be easier than addressing it, but the following are a few of the many reasons to get your pain under control: 

• Overall better quality of life
• Regain physical ability to do activities you enjoy
• Improved mental health
• Improved sleep patterns
• Higher CKD survival rate

What types of pain do people with CKD typically have?

To treat your pain, you must make an appointment with your doctor. Your doctor will ask you questions to understand what type of pain you are experiencing to develop a personalized treatment plan. 

For people with CKD, the following are the most common types of pain:

• Nociceptive (mechanical) pain is caused by stimulation of the nociceptors, which are pain receptors for tissue injuries, such as your skin or internal organs. 
• Neuropathic (nerve) pain can be caused by damage to the nerve itself or dysfunction in the nervous system. Tingling, numbness, burning, or stabbing are common with nerve damage. 
• Musculoskeletal pain occurs in the muscles, bones, and joints, such as arthritis. 
• Inflammatory pain is caused by inflammation in a certain area of the body. An example of this pain is gout pain. 

Commonly used treatments for pain 

Once your doctor understands your pain cause and type, he or she will discuss treatment options. 

The following are commonly used treatments for pain that you may be prescribed:  

•  Non-anti-inflammatory: 
  • Acetaminophen (Tylenol): Usually a safe, over-the-counter pain medicine for most CKD patients
  • Opioids (narcotics): Effective in treating pain but addition and drug abuse is a huge concern 

• Anti-inflammatory:
  • NSAIDs (ibuprofen, meloxicam): Not usually recommended for CKD patients as it may lead to an acute kidney injury 
  • Steroids (prednisone): Needs to be taken under medical guidance but is a common way to treat gout or arthritis 

• Topical agents: Often used to treat access-site pain for dialysis patients

• Gabapentin: Commonly prescribed for CKD patients to treat diabetic neuropathy and shingles pain
• Antidepressants: Commonly used for nerve pain but may take one week to several weeks before pain relief is felt

• RICE: Treatment that stands for “Rest, Ice, Compression, and Elevation” and can promote healing and flexibility in areas injured from sprains or strains

• Injections: Epidural, steroid, or botulinum toxin injections that are given as an outpatient procedure (may require sedation) and can help with nerve, musculoskeletal, or inflammation pain
• Surgery: Surgical decompression, or removing a mass or organ, to help decrease mechanical or nerve pains 

Lifestyle changes for neck and back pain

Dr. Chen reports neck and back pain caused by poor posture can be improved and treated with ergonomics.

Here are a few tips to help reduce pain and strain in those areas: 

• Use a neck pillow when sitting during dialysis.
• Maintain good posture throughout the day.
• Make sure you have a good mattress to sleep on.
• Stretch and exercise daily.
• Use ergonomic chairs and desks when sitting for prolonged periods.

*Fatima, U. (2020, Feb. 3). Webinar recap: Pain management and kidney disease. American Kidney Fund. https://www.kidneyfund.org/kidney-today/pain-management-and-kidney-disease.html