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Review
. 2021 Jan;41(1):68-81.
doi: 10.1016/j.semnephrol.2021.02.007.

Nonpharmacologic Treatments for Opioid Reduction in Patients With Advanced Chronic Kidney Disease

Carrie E Brintz  1 , Martin D Cheatle  2 , Laura M Dember  3 , Alicia A Heapy  4 , Manisha Jhamb  5 , Amanda J Shallcross  6 , Jennifer L Steel  7 , Paul L Kimmel  8 , Daniel Cukor  9 ; HOPE Consortium
Affiliations
Review

Nonpharmacologic Treatments for Opioid Reduction in Patients With Advanced Chronic Kidney Disease

Carrie E Brintz et al. Semin Nephrol. 2021 Jan.

Abstract

Opioid analgesics carry risk for serious health-related harms in patients with advanced chronic kidney disease (CKD) and end-stage kidney disease. In the general population with chronic noncancer pain, there is some evidence that opioid reduction or discontinuation is associated with improved pain outcomes; however, tapering opioids abruptly or without providing supportive interventions can lead to physical and psychological harms and relapse of opioid use. There is emerging evidence that nonpharmacologic treatments such as psychosocial interventions, acupuncture, and interdisciplinary pain management programs are effective approaches to support opioid dose reduction in patients experiencing persistent pain, but research in this area still is relatively new. This review describes the current evidence for nonpharmacologic interventions to support opioid reduction in non-CKD patients with pain and discusses the application of the available evidence to patients with advanced CKD who are prescribed opioids to manage pain.

Keywords: Opioid reduction; dialysis; kidney disease; nonpharmacological treatment; pain.

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Conflict of interest statement

Conflict of Interest Statement: Laura M. Dember receives compensation from the National Kidney Foundation as a Deputy Editor of the American Journal of Kidney Diseases and consulting fees from Merck. The authors have no other conflicts of interest to report.

Figures

Figure 1.
Figure 1.
Conceptual model relating non-pharmacological pain treatments to decreased opioid use and improved health outcomes in patients with advanced chronic kidney disease.
See this image and copyright information in PMC

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