1. Non-Pharmacological Pain Management in CKD Patients
พ.ญ.ชญานิน เวชภูติ
21 January 2017

2. Pain and CKD 53% had chronic MSK pain 58%: severe pain
Non-haemodialysis patients
53% had chronic MSK pain
58%: severe pain
28.4% : moderate pain
15.6%: mild pain
Multifactorial associated
Independently associated with hyperuricemia and the product of calcium × phosphate level
Hsu, et al. Factors associated with chronic musculoskeletal pain in patients with chronic kidney disease. BMC Nephrology 2014; 15:6

3. Pain and CKD MSK was the most cause (63.1%)
Haemodialysis patients (1)
MSK was the most cause (63.1%)
Related to dialysis procedure (13.6%)
Peripheral neuropathy (12.6%)
Peripheral vascular disease (9.7%)
Others
58% of CKD patients experience pain (2)
49% of patients rate their pain as moderate or severe
Davison SN. Pain in Hemodialysis patients: prevalence, cause, severity, and management. Am J Kidney Dis 2003; 42:
Davison SN, Koncicki H, Brennan F. Pain in chronic kidney disease: a scope review. Seminar in dialysis 2014; 27(2):

4. Management of pain Pain is a common problem in patients with ESRD
35.1% : no analgesics
54%: non pharmacological strategies
74.8% had inadequate treatment
Pharmacological: the WHO analgesic ladder
Davison SN. Pain in Hemodialysis patients: prevalence, cause, severity, and management. Am J Kidney Dis 2003; 42:

5. Non-pharmacological management
Cognitive-behavioral therapies
Peripheral therapies
Non-pharmacological
Other therapies

6. Non-pharmacological management
Education & CBT (C)
Brief education should be given to patients with chronic pain to help patients continue to work
Progressive relaxation or EMG biofeedback should be considered for the treatment of patients with chronic pain.
Cognitive behavioral therapy should be considered for the treatment of patients with chronic pain
Scottish Intercollegiate Guidelines Network (SIGN). Management of chronic pain. Edinburgh: SIGN; 2013

7. Non-pharmacological management
Physical therapies (B)
Manual therapy should be considered for short term relief of pain for patients with chronic low back pain.
Manual therapy, in combination with exercise, should be considered for the treatment of patients with chronic neck pain.
Exercise and exercise therapies, regardless of their form, are recommended in the management of patients with chronic pain.
A: Advise to stay active should be given in addition to exercise therapy for patients with chronic low back pain.
Scottish Intercollegiate Guidelines Network (SIGN). Management of chronic pain. Edinburgh: SIGN; 2013

8. Non-pharmacological management
Electrotherapy
B: TENS should be considered for the relief of chronic pain.
B: LLLT should be considered as a treatment option for patients with chronic LBP.
A: Acupuncture should be considered for short term relief of pain in patients with chronic LBP or osteoarthritis.
Scottish Intercollegiate Guidelines Network (SIGN). Management of chronic pain. Edinburgh: SIGN; 2013

9. Non-pharmacological management
Low level laser therapy (LLLT)
There is some evidence that LLLT is an effective treatment for a range of tendinopathy.
There is moderate evidence that LLLT is effective in the treatment of chronic pain.
There is insufficient to support the use of LLLT in the pain management of joint disorders.
Huang L. Evidence based review. Low level laser therapy (LLLT) for musculoskeletal pain. ACC; 2014

10. Non-pharmacological management

11. Non-pharmacological management

12. Non-pharmacological management

13. Non-pharmacological management

14. Non-pharmacological management

15. Non-pharmacological management

16. คำถาม ????