A stepwise approach for effective management of chronic pain in autosomal-dominant polycystic kidney disease

Abstract

Chronic pain, defined as pain existing for >4-6 weeks, affects >60% of patients with autosomal-dominant polycystic disease (ADPKD). It can have various causes, indirectly or directly related to the increase in kidney and liver volume in these patients. Chronic pain in ADPKD patients is often severe, impacting physical activity and social relationships, and frequently difficult to manage. This review provides an overview of pathophysiological mechanisms that can lead to pain and discusses the sensory innervation of the kidneys and the upper abdominal organs, including the liver. In addition, the results of a systematic literature search of ADPKD-specific treatment options are presented. Based on pathophysiological knowledge and evidence derived from the literature an argumentative stepwise approach for effective management of chronic pain in ADPKD is proposed.

Keywords: ADPKD; management; pain; polycystic kidney disease; polycystic liver disease.

FIGURE 1:

Schematic drawing of the sensory nerve supply of kidneys and upper abdominal organs via sympathetic pathways. Solid line: major splanchnic nerve providing sensory innervation of the upper abdominal organs, including the liver via the celiac plexus. Dotted line: lesser splanchnic nerve providing sensory innervation of the renal parenchyma and ureter. Dashed line: least splanchnic nerve providing sensory innervation of the renal capsule. The perivascular nerve plexus around the renal artery forms the final common pathway to and from the kidney. ST, sympathetic trunk.

FIGURE 2:

Proposed management algorithm for chronic pain in ADPKD patients, starting with measures that are nonpharmacological, progressing to pharmacological, minimal invasive and ultimately to complex, invasive therapies.