Assessment and management of pain in hemodialysis patients: A pilot study
Languages of publication
Purpose: To assess pain levels of hemodialysis (HD) patients and to report pain management techniques. Materials and methods: A quantitative descriptive study design with a summative approach to qualitative analysis was held, with a personal interview of the HD patients in a Southern European city hospital (n=70), using the Visual Analog Scales (VAS), the Wong-Baker Pain Scales (WBPS) and McGill Pain Questionnaire. People confused or in a coma, with hearing or reading problems and inability to communicate in the spoken language were excluded. Results: Renal patients under investigation were 69.72 ±12.45 years old, male (58.5%) and on HD for 35.5 ± 27.4 months. In the Wong Baker Scale, pain was rated as “hurts little more” 30.8%, (n=20) and in the VAS 30.8% (n=20) reported 6/10 the amount of pain experienced. Forty-six percent pinpointed internal pain in the legs. Pain experienced was characterized as sickening (70.8%), tiring (67.7%), burning (66.2%), rhythmic (86.2%), periodic (66.2%) and continuous (61.5%). The patients studied mainly manage pain either with warm towel/cloth (85.2% females and all male patients), with massage (84.2% and 88.9%, respectively) or painkillers (47.4% and 52.6%, respectively). In a correlation of gender and pain management techniques, statistical significance was found only with warm towel (p=0.038). Conclusions: As renal patients are an increasing group of healthcare service users, and pain is affecting their everyday life, it is essential to individualize pain evaluation and to provide further education to clinical nurses so that they can effectively manage pain.
- Williams A, Manias E. A structured literature review of pain assessment and management of patients with chronic kidney disease. J Clin Nurs. 2008 Jan;17(1): 69-81.
- Eggers PW. Has the incidence of end-stage renal disease in the USA and other countries stabilized? Curr Opin Nephrol Hypertens. 2011 May; 20(3):241–5.
- Chalmers C. Applied anatomy and physiology and the renal disease process. In: Thomas N (ed), 2008. Renal Nursing. London: Elsevier Health Sciences; p. 27-74.
- Pham PC, Dewar K, Hashmi S, Toscano E, Pham PM, Pham PA, Pham PT. Pain prevalence in patients with chronic kidney disease. Clin Nephrol. 2010 Apr;73(4):294-9.
- Kafkia T, Chamney M, Drinkwater A, Pegoraro M, Sedgewick J. Pain in Chronic Kidney Disease: prevalence, cause and management. J Ren Care. 2011 Jun;37(2):114-22.
- Bailie G, Mason N, Bragg-Gresham J, Gillespie B, Young E. Analgesic prescription patterns among haemodialysis patients in the DOPPS: Potential for underprescription. Kidney Int. 2004 Jun; 65(6): 2419-25.
- Mercadante S, Ferrantelli A, Tortorici C, Lo Cascio A, Lo Cicero M, Cutaia I, Parrino I, Casuccio A. Incidence of chronic pain in patients with end-stage renal disease on dialysis. J Pain Symptom Manage. 2005 Oct;30(4):302-4.
- Merskey H, Bogduk N. Classification of chronic pain, IASP task force on taxonomy. 2nd ed. Seattle, WA: IASP Press; 2011. Part III: Pain Terms, A Current List with Definitions and Notes on Usage; p. 209-14.
- Noble H, Kelly D, Rawlings-Anderson K, Meyer J. A concept analysis of renal supportive care: the changing world of nephrology. J Adv Nurs. 2007 Sep;59(6):644-53.
- Finkelstein FO, West W, Gobin J, Finkelstein SH, Wuerth D. Spirituality, quality of life and the dialysis patient. Nephrol Dial Transplant. 2007 Sep;22(9):2432-4.
- Polkki T, Pietila A, Vehnilainen-Julkunen K, Laukkala H, Kiviluoma K: Imagery-induced relaxation in children’s postoperative pain relief: a randomized pilot study. J Pediatr Nurs. 2008 Jul; 23(3):217-24.
- Bromley L. Renal Dysfuntion. In: Cox F (ed), 2009. Perioperative pain management. London: Blackwell Publishing; p. 221-2.
- Wong DL, Baker C. Reference manual for the Wong-Baker faces pain rating scale. Duarte: Mayday Pain Resource Center; 1995.
- Aitken R. Measurement of feelings using visual analogue scales. Proc R Soc Med. 1969 Oct; 62(10):989-93.
- Melzack R. The short-form McGill Pain Questionnaire. Pain 1987 Aug; 30(2):191-7.
- Mystakidou K, Parpa E, Tsilika E, Kalaidopoulou O, Georgaki S, Galanos A, Vlahos L. Greek McGill Pain Questionnaire: validation and Utility in cancer patients. J Pain Symptom Manage 2002 Oct; 24(4):379-87.
- Davison SN. Chronic pain in end-stage renal disease. Adv Chr Kidney Dis. 2005 Jul; 12(3):326-34.
- Terzibasioglu AM, Akarirmak U, Saridogan M, Tuzun S. Correlation of back pain, compression fracture and quadriceps muscle strength with bone mineral density in renal insufficiency patients. Eur Medicophys. 2005 Dec;41(4):303-8.
- Kelly A, Apostle K, Sanders D, Bailley H. Musculoskeletal pain in dialysis-related amyloidosis. Can J Surg. 2007 Aug; 50(4):305-6.
- Figueiredo AE, Viegas A, Monteiro M, Poli-de Figueiredo CE. Research into pain perception with arteriovenous fistula (AVF) cannulation. J Ren Care.2008 Dec;34(4):169-72.
- Milinkovic M, Zidverc-Trajkovic J, Sternic N, Trbojevic-Stankovic J, Maric I, Milic M, Andric B, Nikic P, Jovanovic P, Rosic P, Stojimirovic B. Hemodialysis headache. Clin Nephrol. 2009 Feb;71(2):158-63.
- Alhani F, Shad H, Anoosheh M, Hajizadeb E. The effect of programmed distraction on the pain caused by venipuncture among adolescents on hemodialysis. Pain Manag Nurs. 2010;11(2):85-91.
- Weisbord SD, Fried LF, Arnold RM, Fine MJ, Levenson DJ, Peterson RA, Switzer GE. Prevalence, severity and importance of physical and emotional symptoms in chronic heamo-dialysis patients. J Am Soc Nephr. 2005 Aug; 16(8):2487-94.
- Kimmel PL, Peterson RA. Depression in Patients with End-Stage Renal Disease Treated with Dialysis: Has the Time to Treat Arrived? CJASN. 2006 Jan; 1(3):349-52.
- Kontodimopoulos N, Pappa E, Niakas D. Gender- and age-related benefit of renal replacement therapy on health-related quality of life. Scand J Caring Sci. 2009 Dec;23(4):721-9.
- Bailie GR, Mason NA, Bragg-Gresham IL Analgesic prescription patterns among haemodialysis patients in the DOPPS: protential for underprescription. Kidney Int. 2004 Jun; 65(6):2419-25.
- Levey A, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, De Zeeuw D, Hostetter T, Lameire N, Eknoyan G. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005 Jun;67(6):2089–100.
- Andreucci VE, Fissell RB, Bragg-Gresham JL, Ethier J, Greenwood R, Pauly M, Wizemann V, Port FK: Dialysis Outcomes and Pracitce Patterns Study (DOPPS) Data on Medications in Haemodialysis Patients. Am J Kidney Dis. 2004;44(5 Sup):S61-S7.
- Spiegel B, Melmed G, Robbins S, Esrailian E. Biomarkers and Health-related quality of life in End-Stage Renal Disease: a systematic review. Clin J Am Soc Nephrol. 2008 Nov; 3(6):1759-68.
- Conway BR, Fogarty DG, Nelson WE, Doherty CC. Opiate toxicity in patients with renal failure. BMJ 2006; Feb 11;332(7537):345-6.
- Hardy JR, Herbert AR, Reymond E. Opioids in patients on renal dialysis. J Pain Symptom Manage. 2007 Jan; 33(1):1-2.
- Eğlence R, Karataş N, Taşci S. The effect of acupressure on the level offatigue in hemodialysis patients. Altern Ther Health Med. 2013 Nov-Dec; 19(6):23-31.
- Hogan MC, Norby SM. Evaluation and management of pain in autosomal dominant polycystic kidney disease. Adv Chronic Kidney Dis. 2010 May;17(3):e1-e16.
- Grantham D, Brown S for the Winnipeg Regional Health Authority Group Pain Assessment and Management Clinical Practice Guidelines [cited 2014 Jan 20]. Available from: http://www.wrha. mb. ca/ professionals/ebpt/files/PAM_CPG.pdf
- Bohm C, Ho J, Duhamel T. Regular physical activity and exercise therapy in end-stage renal disease: how should we “move” forward? J Nephrol. 2010 May-Jun; 23(3):235-43.
- Kafkia T, Zinelis D, Kourakos M. Exercise protocols in patients with Chronic Kidney Disease (CKD) and on Renal Replacement Therapy: A literature review. Hellenic J Nurs Sc. 2008; 1(2):55-9.
Publication order reference