Journal
SEMINARS IN NEPHROLOGY
Volume 41, Issue 6, Pages 550-562Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.semnephrol.2021.10.007
Keywords
Pain; chronic kidney disease; pain catastrophizing; illness-induced PTSD; symptom clustering
Categories
Funding
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health [U01DK123787]
- National Institute of Nursing Research, National Institutes of Health [K23NR018482]
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Patients with chronic kidney disease often experience moderate to severe pain, compounded by comorbid depression and anxiety. Nonpharmacologic treatments targeting pain, depression, and anxiety show promise, but their effects in this population are still largely unknown.
Patient reports of moderate to severe pain are common across the spectrum of chronic kidney disease. The synergistic effects of comorbid depression and anxiety can lead to maladaptive coping responses to pain, namely pain catastrophizing and illness-related post-traumatic stress disorder. If underlying depression and anxiety and associated maladaptive coping responses are not treated, patients can experience an increased perception of pain, worsened disability, decreased quality of life, withdrawal from social activities, and increased morbidity and mortality. Meanwhile, interest in nonpharmacologic treatments for pain that targets coping as well as comorbid anxiety and depression has been increasing, particularly given the significant societal damage that has resulted from the opioid epidemic. Evidence-based, nonpharmacologic treatments have shown promise in treating pain in areas outside of nephrology. Currently, little is known about the effects of these treatments among adults with CKD, and particularly end-stage kidney disease, when chronic pain can become debilitating. In this review, we examine patient-centered concepts related to pain that have received little attention in the nephrology literature. We also describe emerging areas of research, including omics technologies for biomarker discovery and advanced symptom clustering methods for symptom phenotyping, which may be useful to future kidney disease research and treatment. Semin Nephrol 41:550-562 (c) 2021 Elsevier Inc. All rights reserved.
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