The Present and Future of Pain Management in Patients With Chronic Kidney Disease: A Narrative Review

Chronic kidney disease (CKD) is an increasingly common ailment, greatly affecting the quality of life, morbidity, and mortality of the population. In addition, more than half of patients with CKD experience chronic pain, mostly of nociceptive or neuropathic origin, and physicians frequently have to find a difficult balance between safety and efficacy to control it. The altered metabolism and renal excretion in patients with CKD modify the pharmacokinetics and pharmacodynamics of several analgesic drugs, making this population more prone to side effects and lower efficacy, since the doses often need to be reduced. This narrative review describes the current pharmacological approaches for nociceptive and neuropathic pain, and emerging alternatives, such as cannabinoids and low-dose naltrexone. We also describe the current knowledge on anesthesia, perioperative and acute pain management, and injectables, including ketamine and corticosteroids (intra-articular and epidural). In the variable and possibly deteriorating clinical context of CKD, this review shows that pain management needs to be individualized and carefully discussed with the patient; close monitoring is also necessary to adjust the treatment and obtain effective pain control while minimizing the risk.