Emerging Patient-Centered Concepts in Pain Among Adults With Chronic Kidney Disease, Maintenance Dialysis, and Kidney Transplant

Abstract

Patient reports of moderate to severe pain are common across the spectrum of chronic kidney disease. The synergistic effects of comorbid depression and anxiety can lead to maladaptive coping responses to pain, namely pain catastrophizing and illness-related post-traumatic stress disorder. If underlying depression and anxiety and associated maladaptive coping responses are not treated, patients can experience an increased perception of pain, worsened disability, decreased quality of life, withdrawal from social activities, and increased morbidity and mortality. Meanwhile, interest in nonpharmacologic treatments for pain that targets coping as well as comorbid anxiety and depression has been increasing, particularly given the significant societal damage that has resulted from the opioid epidemic. Evidence-based, nonpharmacologic treatments have shown promise in treating pain in areas outside of nephrology. Currently, little is known about the effects of these treatments among adults with CKD, and particularly end-stage kidney disease, when chronic pain can become debilitating. In this review, we examine patient-centered concepts related to pain that have received little attention in the nephrology literature. We also describe emerging areas of research, including omics technologies for biomarker discovery and advanced symptom clustering methods for symptom phenotyping, which may be useful to future kidney disease research and treatment.

Keywords: Pain; chronic kidney disease; illness-induced PTSD; pain catastrophizing; symptom clustering.

Figure 1.. Loeser’s conceptual model for pain in chronic kidney disease (nephropathy)

Abbreviations: PTSD, post-traumatic stress disorder.

Figure 2.. Theoretical application of NIH Symptom Science Model in chronic kidney disease

Abbreviations: ACT, acceptance and commitment therapy; CBT, cognitive behavioral therapy; NIH, National Institutes of Health.

Figure 3.. The effects of the BGMA on regulatory pathways associated with pain experience.

Abbreviations: 3-HK, 3-hydroxykynurenine; ATCH, adrenocorticotropic hormone; BGMA, brain-gut-microbiome axis; CRH, corticotropin-releasing hormone; HPA: hypothalamus-pituitary-adrenal axis; IDO1, indoleamine 2,3-dioxygenase; KYN, kynurenine; QUIN, quinolinic acid.