Pain In Hemodialysis Patients Research Articles

#2579 Chronic pain in chronic kidney disease: differences between stages and replacement therapies

Abstract Background and Aims Pain is one of the most common symptoms among patients with End-Stage Renal Disease (ESRD), often going unrecognized or inadequately managed in people undertaking hemodialysis. Over 50% of people on hemodialysis experience pain, with 75% of them being ineffectively treated due to healthcare professionals' lack of awareness of this symptom. Managing pain in this population is a complex and challenging task for healthcare professionals. Variables related to chronic pain can influence the patient's response to pain. There is a gap in the literature on this topic, as it has not been studied whether patients with ESRD undergoing hemodialysis exhibit characteristics of chronic pain that may be influencing their pain response. The objective of this study is to evaluate the presence and characteristics of variables related to chronic pain in hemodialysis patients with ESRD to assess whether including the management of chronic pain is relevant in the holistic treatment of these patients. Method This is a cross-sectional observational study that is currently ongoing. Participants included subjects that were willing to participate, with chronic kidney disease (CKD) stages 3 and 4, CKD stage 5 in hemodialysis and transplanted patients. Several questionnaires were recorded to report different aspects related to chronic pain. The Kruskal-Wallis test was used to assess differences between groups. Results Preliminary results on 26 subjects are shown in Table 1. No significant differences were found between groups. Transplanted and hemodialysis patients (in the hospital) experience more sleep disturbances and more pain catastrophizing. Transplanted and hemodialysis patients (in the hospital) present higher belief in their abilities to handle stressful situations in daily life, but they also suffer more headaches. Hemodialysis patients (hospital and home) present higher levels of anxiety and depression. Hemodialysis patients (at home) and transplanted patients exhibit higher levels of stress conditions. Finally, patients undergoing hemodialysis (in the hospital) and CKD stages 3 and 4 present higher levels of chronic pain. Conclusion A bigger sample is needed. However, based on the data, it seems that patients with CKD exhibit characteristics of chronic pain that should be addressed by healthcare professionals.

Pengaruh Benson Terhadap Nyeri Insersi pada Pasien yang Menjalani Hemodialisa di RSUD Kota Tanjungpinang

Insertion pain is pain caused by the action of inserting a needle into the AV fistula as a link between blood vessel circulation and the hemodialysis machine during the hemodialysis process. In Brazil it was found that 70% of patients undergoing hemodialysis experienced mild to moderate pain at the time of AV fistula insertion. The phenomenon found in the hemodialysis unit at Tanjungpinang City Regional Hospital in 2020 was 33 patients experiencing moderate pain. This research was conducted to determine the effect of the Benson relaxation technique on pain during insertion in patients undergoing hemodialysis. The research method is a quasi experimental design, with a pre test – post test design approach without control group. The sample consisted of 30 respondents in the intervention and control groups who were routine hemodialysis patients at the Tanjungpinang City Regional Hospital in 2023. Using a non-probability sampling technique, consecutive sampling. Data were processed using the Wilcoxon signed rank test. Univariate analysis of results before the Benson technique, 73.3% experienced moderate pain and after the Benson technique, 80% did not feel pain in the intervention group. It was concluded that there was an influence of the Benson technique on insertion pain in patients undergoing hemodialysis. It is hoped that the Benson relaxation technique will be applied by nurses as non-pharmacological pain management to reduce AV-fistula insertion pain in hemodialysis patients.

Evaluation of Pain Intensity Related to Arteriovenous Fistula Puncture among Hemodialysis Patients

Background: Pain associated with arteriovenous fistula puncture is a significant problem among hemodialysis patients. The process of needle insertion often causes considerable physical and psychological discomfort, leading to a decrease in perceived quality of life. Study Objective : Evaluate the level of pain experienced by hemodialysis patients due to arteriovenous fistula puncture. Methods and Materials: A cross-sectional study design was used, with a sample size of 40 patients under hemodialysis. The intensity of pain was measured for these patients during the needle insertion by means of a rating analogies scale. The selection of the study sample was done through a purposive sample from a hospital setting. Data collection was conducted using the rating analogies scale. Descriptive statistics were used to analyze the data on pain intensity. Results: The results showed that the intensity of pain ranged from moderate to severe. The discussion of the results focused on the implications of the findings for clinical practice and the need for further research in the area. The study highlighted the importance of considering the intensity of pain related to arteriovenous fistula puncture among hemodialysis patients, and the need for further research into interventions that can reduce the associated pain. Conclusion and Recommendations : Based on the results of the study, it can be concluded that arteriovenous fistula puncture causes moderate to severe pain in hemodialysis patients. Therefore, it is recommended that healthcare providers should take necessary measures to reduce the intensity of pain during the procedure. These measures may include the use of pain-relieving medications and other methods such as distraction , relaxation techniques and cryotherapy.

Prevalence of chronic pain in hemodialysis patients and its correlation with C-reactive protein: a cross-sectional study

End-stage renal disease (ESRD) is a common chronic disease worldwide that requires hemodialysis. Patients may face chronic pain and poor quality of life. Therefore, a better understanding of these variables in hemodialysis patients is essential to provide a good intervention. We aim to determine how common chronic pain is in hemodialysis patients and its correlation with sociodemographics, C-reactive protein (CRP), calcium, phosphorus, albumin, and parathyroid hormone. A cross-sectional study of hemodialysis patients was conducted in Palestine. Data collection took place between November 2020 and May 2021. We used the brief pain inventory score to assess chronic pain, and lab tests detected CRP levels. Data were collected using a convenience sampling technique. There were two hundred sixty-one patients in the present study. The mean age of the patients was 51 years, with 63.6% being men. 47.1% of them reported having chronic pain. Gender (p = 0.011), social status (p = 0.003), educational status (p = 0.010), and number of chronic diseases (p = 0.004) indicated a significant relationship with the severity score of pain. Furthermore, sex (p = 0.011), social status (p = 0.003), and number of chronic diseases (p = 0.002) were significantly associated with the pain interference score. Additionally, Person’s test indicated significant correlations between CRP and pain severity (p < 0.001) and with pain interference (p < 0.001). Albumin was significantly and negatively correlated with pain severity (p = 0.001) and pain interference (p < 0.001). Multiple linear regression analysis revealed that patients who had a higher CRP level and many chronic diseases were more likely to have a higher pain severity score. However, pain severity was the only predictor for pain interference. Our results suggest that there is a significant correlation between the existence of chronic pain in hemodialysis patients and increased CRP levels. However, further investigations are needed with a larger number of patients in more than one dialysis unit to confirm this correlation and management of chronic pain in patients with HD.

Cooling spray or lidocaine spray and needle insertion pain in hemodialysis patients: an open-label cross-over randomized clinical trial

BackgroundThe needle insertion pain to perform hemodialysis is the main challenge and a common problem that requires pain management techniques for patients’ comfort.AimThis study aimed to compare the effects of cooling and lidocaine sprays on needle insertion pain in hemodialysis patients.MethodsIn this randomized cross-over clinical trial study, the hemodialysis patients were selected through convenience sampling according to inclusion criteria and randomly assigned to three intervention groups using the block randomization method. Each patient received three interventions in a cross-over design: Cooling spray or 10% lidocaine spray or placebo spray. There was a 2-week wash-out time between each intervention. The pain score was measured four times for each patient by the Numerical Rating Scale.ResultsForty-one hemodialysis patients were included. The results showed a significant interaction between time and group (p < 0.05), so only observations of time 1 with adjustment for baseline values were used to evaluate the effect of the intervention. Patients receiving cooling spray reported 2.29 less pain score on average compared to placebo (B=-2.29, 95% CI: -4.17 to -0.43; p < 0.05); Also, patients receiving cooling spray reported a 1.61 lower pain score than those receiving lidocaine spray, but this difference was not statistically significant (95% CI: -0.26 to 3.48; p > 0.05).ConclusionThe cooling spray was effective in reducing the needle insertion pain. Although it was impossible to compare the pain scores at different times and following different interventions, the present study results can help supplement the existing knowledge regarding cooling and lidocaine sprays.

Assessment And Management of Chronic Pain In Hemodialysis Patients: A Pilot Study

This descriptive and cross-sectional study included 89 HD patients. The study was carried out in the hemodialysis unit of a training and research hospital between April August 2022

Pain in Hemodialysis Patients: Prevalence, Intensity, Location, and Functional Interference in Daily Activities.

Although pain is a frequent complaint of patients with chronic kidney disease who undergo hemodialysis, few studies have assessed the functional interference of pain in activities of daily living (ADLs). Hence, the aim of this study was to evaluate the prevalence, location, intensity, and functional interference of pain in ADLs of chronic kidney disease patients undergoing hemodialysis and to estimate the association of specific pain sites with severe functional interference by pain in ADLs. This cross-sectional study included patients with chronic kidney disease undergoing hemodialysis. The prevalence, intensity, and functional interference of pain in ADLs were assessed using the brief pain inventory. Poisson regression was used to calculate the prevalence ratio. A total of 65 patients participated in the study. The overall prevalence of pain was 89.23%; the prevalence of headache was 18.46% and that of pain in the trunk was 55.38%, upper limbs was 35.38%, and lower limbs was 60.00%. The prevalence of moderate and severe pain at the time of hemodialysis was 13.85% and 21.54%, respectively. A high prevalence of severe functional interference of pain in general activity (61.54%), mobility (56.92%), and disposition (55.38%) was observed. Pain is a frequent complaint in patients undergoing hemodialysis, mainly musculoskeletal and intradialytic, and it interferes with ADLs and incapacitates the patient. Pain was highly prevalent in the upper and lower limbs and the trunk. Furthermore, a higher prevalence of severe pain at the time of hemodialysis and functional interference of pain, mainly in general activity, mobility, and disposition, were observed.

Effect of aromatherapy on the pain of arteriovenous fistula puncture in patients on hemodialysis: a systematic review

PurposeThis study aims to determine the effect of aromatherapy used in reducing the pain caused by fistula puncture in hemodialysis patients.Design/methodology/approachIn this study, the effect of aromatherapy application on fistula puncture was analyzed and carried out by scanning the relevant literature. The literature review was conducted between August and October 2020. While reviewing the literature, the authors used “aromatherapy,” “pain,” “fistula,” “puncture,” “hemodialysis” keywords and various combinations of these; moreover, Google scientist, Pubmed, Cochrane, ScienceDirect, Web of Science, Medline and Ovid databases and studies, which were conducted in the last 10 years were reviewed. As a result of the literature review, 1183 studies were reached and seven of them were included in the study by taking the inclusion criteria into account.FindingsThe randomized controlled studies are six studies and nonrandomized controlled experimental 1 study were added to the scope of the study and seven studies were included in the sample. In these studies, personal information forms developed by the researchers as data collection tools and the VAS scale, Numerical pain rating, the numeric rating scale were used to evaluate pain.Practical implicationsIt has been determined that aromatherapy application in hemodialysis patients has positive effects on reducing pain due to puncture fistula intervention.Originality/valueThis study provides reduction or elimination of fistula needle insertion pain in hemodialysis patients.

Factors associated with hip pain in end-stage renal disease patients on prevalent hemodialysis: a cross-sectional study

BackgroundHemodialysis (HD) patients suffer from musculoskeletal disorders. The most reported musculoskeletal problem is arthralgia. Hip arthralgia has been commonly reported in patients undergoing HD. Hip pain can lead to a decrease in levels of physical activity, limitation in joint range of motion, and consequently difficulties in performing activities of daily living (ADL) and impair the quality of life (QoL). The aim of the study is to reveal the prevalence of hip pain and related factors in HD patients. This cross-sectional study included 73 patients on prevalent HD whose ages ranged from 25 to 65 years and who were on HD for more than 6 months. Physical examination and radiological imaging were done to every patient. Visual analog scale, Barthel Index, and Short Form-36 were used to evaluate pain, ADL, and QoL, respectively.ResultsHip arthralgia was detected in 32 patients. Around 43% of which were diagnosed hip osteoarthritis, 34% greater trochanteric pain syndrome, 15% femoroacetabular impingement, and 6% soft tissue calcifications. Diabetes mellitus and hemodialysis duration were found to be significantly different between the groups of hip pain and without hip pain. Diabetes mellitus was identified as an independent risk factor for hip pain in hemodialysis patients. ADL and QoL were significantly lower in patients with hip pain compared to those without (p < 0.01; p < 0.05, respectively).ConclusionsThe results of our research show that HD patients should be screened for the presence of hip pain and other musculoskeletal disorders and that this is an area which requires further consideration and medical research.

Exploring factors associated with pain in hemodialysis patients: a multicenter cross\u2010sectional study from Palestine

BackgroundChronic kidney disease (CKD) is a rising medical concern around the world. End-stage kidney disease (ESKD) is the last stage of CKD stages that necessitates renal replacement therapy (RRT), such as hemodialysis (HD), which seems to be the most commonly used type. However, patients on HD still suffer from high mortality and morbidity rates compared to those who receive a kidney transplant. Therefore, we aimed in this study to assess the prevalence of pain among ESKD patients on HD, as well as to explore the factors that were associated with this complaint.MethodsWe conducted a multicenter cross-sectional study in the West Bank, Palestine, between August and November 2018. We used questionnaire-based direct interviews with subjects. After reviewing previous studies in the field, we developed our questionnaire and included items on patients’ social, demographic, and clinical characteristics, including dialysis-related data. It also contained the Brief Pain Inventory (BPI) to assess different aspects of pain symptoms. A convenience sampling technique was used to collect data.ResultsOf the 300 participants, 66.3 % reported having chronic pain. HD sessions themselves were the most commonly cited cause for pain (21.6 %). The most commonly cited site of pain was the upper and lower limbs (37.3 %). Paracetamol was the most frequently used pharmacotherapy for pain alleviation. Multiple regression analysis showed that BMI (p = 0.018), gender (p = 0.023), and the number of comorbidities (p < 0.001) were independently associated with pain severity score.ConclusionsPain is a highly prevalent symptom among HD patients in Palestine. Subpopulations with higher pain severity include females, patients with higher BMI, and those with multiple comorbidities. Healthcare providers should routinely assess pain in HD patients as it is considered a significant concern. This would involve pain assessment and development of a treatment plan to improve clinical outcomes. The nephrology associations should also push for pain management in HD patients as a clinical and research priority to improve pain-related disability.

The Prevalence and Severity of Chronic Pain in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Background:Chronic pain is a common and distressing symptom reported by patients with chronic kidney disease (CKD). Clinical practice and research in this area do not appear to be advancing sufficiently to address the issue of chronic pain management in patients with CKD.Objectives:To determine the prevalence and severity of chronic pain in patients with CKD.Design:Systematic review and meta-analysis.Setting:Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity.Patients:Adults with glomerular filtration rate (GFR) category 3 to 5 CKD including dialysis patients and those managed conservatively without dialysis.Measurements:Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of pain, and severity of pain.Methods:Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library, last searched on February 3, 2020. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of overall chronic pain, musculoskeletal pain, bone/joint pain, muscle pain/soreness, and neuropathic pain and the I2 statistic was computed to measure heterogeneity. Random effects models were used to account for variations in study design and sample populations and a double arcsine transformation was used in the model calculations to account for potential overweighting of studies reporting either very high or very low prevalence measurements. Pain severity scores were calibrated to a score out of 10, to compare across studies. Weighted mean severity scores and 95% confidence intervals were reported.Results:Sixty-eight studies representing 16 558 patients from 26 countries were included. The mean prevalence of chronic pain in hemodialysis patients was 60.5%, and the mean prevalence of moderate or severe pain was 43.6%. Although limited, pain prevalence data for peritoneal dialysis patients (35.9%), those managed conservatively without dialysis (59.8%), those following withdrawal of dialysis (39.2%), and patients with earlier GFR category of CKD (61.2%) suggest similarly high prevalence rates.Limitations:Studies lacked a consistent approach to defining the chronicity and nature of pain. There was also variability in the measures used to determine pain severity, limiting the ability to compare findings across populations. Furthermore, most studies reported mean severity scores for the entire cohort, rather than reporting the prevalence (numerator and denominator) for each of the pain severity categories (mild, moderate, and severe). Mean severity scores for a population do not allow for “responder analyses” nor allow for an understanding of clinically relevant pain.Conclusions:Chronic pain is common and often severe across diverse CKD populations providing a strong imperative to establish chronic pain management as a clinical and research priority. Future research needs to move toward a better understanding of the determinants of chronic pain and to evaluating the effectiveness of pain management strategies with particular attention to the patient outcomes such as overall symptom burden, physical function, and quality of life. The current variability in the outcome measures used to assess pain limits the ability to pool data or make comparisons among studies, which will hinder future evaluations of the efficacy and effectiveness of treatments. Recommendations for measuring and reporting pain in future CKD studies are provided.Trial registration:PROSPERO Registration number CRD42020166965

Progressive muscle relaxation to reduces chronic pain in hemodialysis patient

Background: Hemodialysis is a kidney replacement therapy, but it has many complications identified, one of them is pain. Thus, we need non-pharmacological interventions that can be done by nurses, among them is progressive muscle relaxation (PMR), which is economically-efficient and no side effects.Objective: To determine the effect of progressive muscle relaxation on pain in hemodialysis patients.Methods: This is a quasi experimental design of time series design. The number of samples was 100 patients taken by simple random sampling. Progressive muscle relaxation (PMR) was given every day for 4 weeks. Research instrument applied was Brief Pain Inventory. The data analysis employed independent t-test.Results: There was a decrease in pain level from week to week after the intervention, from the scale of 6 (moderate pain) to scale 3 (mild pain). There was a difference in the level of pain between the intervention group and the control group p &lt;0.001.Conclusion: The therapy of non-pharmacological using a progressive muscle relaxation is proven to reduce pain in hemodialysis patients.

Elbow Pain in Hemodialysis Patients and Its Effect on Daily Living Activities of the Patients

Elbow Pain in Hemodialysis Patients and Its Effect on Daily Living Activities of the Patients

Cold spray for reducing venopuncture pain in hemodialysis patients; a randomized double-blinded controlled trial

Introduction: The pain due to cannulation and needle insertion into blood vessels becomes problematic among patients suffering hemodialysis. Objectives: The present study aimed to assess the pain relieving effects of cooling sprays among patients undergoing hemodialysis. Patients and Methods: Eighty patients aged higher than 18 years who were on chronic hemodialysis were randomly assigned into two groups including the group received cooling spray for relieving pain (n = 40) and the group received stilled water as placebo (n = 40). In the intervention group and in a hemodialysis session, 2 puffs of the Cramer Cold Spray were sprayed 30 seconds before the cannulation. The pain severity was assessed by the visual analogue scale (VAS) method. Results: The mean of pain severity score was not different between the intervention and control group before intervention, however after intervention, the patients in the intervention group experienced milder pain due to cannulation as compared to control group (3.28 ± 1.13 versus 5.30 ± 1.76; P &lt; 0.001). Interviewing with the patients receiving cooling spray showed willingness to the use of spray in 87.5% of cases. The local complication due to the use of cold spray was revealed only in 5% of patients. Conclusion: The use of cooling spray in hemodialysis patients can reduce the pain caused by needle insertion. This method can be routinely used as a non-pharmacological pain relief method to reduce pain in hemodialysis patients

Role of Ultrasound in Assessment of Joint Pain among Hemodialysis Patients

Background: Few studies including limited number of patients assessed the rheumatologic effects of hemodialysis (HD) on joints using ultrasonography. Joint ultrasound has been emerged as a cheap non-invasive tool for assessment of joint pain among HD patients. This was the aim of our study to make use of such tool in such life quality threatening complaint. Objective: to determine the role of ultrasound in evaluation of joint pain and its causes among patients on regular HD. Patients and Methods: One hundred and four patients with end stage renal disease (ESRD) who were regular on HD three sessions per week four hours per session were subjected to history taking, complete physical examination stressing on musculoskeletal examination and ultrasonography of painful joints by an ultrasonography expert. Results: Dialysis related arthropathy (DRA) was not the only cause of joint pain among HD patients but there were diverse causes in different joints. As regard affected joints, knee was the most affected one then came wrist, shoulder, ankle and elbow respectively. As regard causes of joint pain, DRA was the commonest one then came osteoarthritis, non-specific ultrasonographic findings and few cases showed normal ultrasonographic studies. Conclusion: This study confirmed that joint pain in HD patients has diverse causes not DRA by necessity but other causes must be considered as well as multifactorial etiologies.

Role of Ultrasound in Assessment of Joint Pain among Hemodialysis Patients

Background: Few studies including limited number of patients assessed the rheumatologic effects of hemodialysis (HD) on joints using ultrasonography. Joint ultrasound has been emerged as a cheap non-invasive tool for assessment of joint pain among HD patients. This was the aim of our study to make use of such tool in such life quality threatening complaint. Objective: to determine the role of ultrasound in evaluation of joint pain and its causes among patients on regular HD. Patients and Methods: One hundred and four patients with end stage renal disease (ESRD) who were regular on HD three sessions per week four hours per session were subjected to history taking, complete physical examination stressing on musculoskeletal examination and ultrasonography of painful joints by an ultrasonography expert. Results: Dialysis related arthropathy (DRA) was not the only cause of joint pain among HD patients but there were diverse causes in different joints. As regard affected joints, knee was the most affected one then came wrist, shoulder, ankle and elbow respectively. As regard causes of joint pain, DRA was the commonest one then came osteoarthritis, non-specific ultrasonographic findings and few cases showed normal ultrasonographic studies. Conclusion: This study confirmed that joint pain in HD patients has diverse causes not DRA by necessity but other causes must be considered as well as multifactorial etiologies.

Comparing the Effect of Ice Massage and Acupressure on the Intensity of the Venipuncture Pain in Hemodialysis Patients

Comparing the Effect of Ice Massage and Acupressure on the Intensity of the Venipuncture Pain in Hemodialysis Patients

The relationship between malnutrition-inflammation and cannulation pain in hemodialysis patients

The relationship between malnutrition-inflammation and cannulation pain in hemodialysis patients

The effect of self-selected soothing music on fistula puncture-related pain in hemodialysis patients

ObjectiveThis study was intended to examine the effect of selective soothing music on fistula puncture-related pain in hemodialysis patients. Materials and methodsThis is a randomized clinical trial in which 114 participants were selected from two hemodialysis units by means of a non-random, convenience sampling method. The participants were then allocated in three groups of music (N = 38), headphone (N = 38), and control (N = 38). The fistula puncture-related pain was measured 1 min after venipuncture procedure in all three groups. The music group listened to their self-selected and preferred music 6 min before needle insertion into a fistula until the end of procedure. The headphone group wore a headphone alone without listening to music 6 min before needle insertion into a fistula until the end of procedure. The control group did not receive any intervention from the research team during needle insertion into a fistula. The pain intensity was measured immediately after the intervention in all three groups. ResultsThis study showed a significant difference between the music and control groups, and the music and headphone groups in terms of the mean pain score after the intervention. However, the analysis did not indicate any significant difference between the headphone and control groups with regard to the mean pain score after the intervention. ConclusionIt is concluded that music can be used effectively for pain related to needle insertion into a fistula in hemodialysis patients. Future research should investigate the comparative effects of pharmacological and non-pharmacological interventions on fistula puncture-related pain.

Effect of cognitive behavior intervention on arteriovenous fistula puncture-related pain in hemodialysis patients

Objective To explore the effect of cognitive behavior intervention on arteriovenous fistula puncture-related pain in hemodialysis patients, and provide evidence for effective pain management. Methods Totals of 96 patients undergoing regular hemodialysis in He'nan Province Hospital of TCM from September 2015 to January 2016 were selected by convenient sampling and randomly divided into observation group and control group, with 48 cases in each group. The final effective cases were 45 cases in each. Patients in the control group received routine pain nursing, while patients in the observation group received cognitive behavior intervention based on the control group. Visual analogue scale, state-trait anxiety inventory and pain self-efficacy questionnaire were used to evaluate patients in two groups before and after intervention. Results There was a significant difference between the two groups on the degree of puncture pain, the scores of anxiety and pain self-efficacy (P<0.05) . Conclusions Cognitive behavior intervention can relieve pain, reduce anxiety emotions, and improve pain self-efficacy in hemodialysis patients undergoing different degree of arteriovenous fistula puncture-related pain . Key words: Pain; Hemodialysis; Cognitive behavior intervention; Arteriovenous fistula