Assessment of pain and effectiveness of analgesia in patient undergoing haemodialysis

Abstract

Pain is the most common symptom in patient’s undergoing haemodialysis, due to comorbidity, although it is frequently underdiagnosed [1-2]. Pain in these patients is not valued in its entirety and does not consider the limitations resulting in their quality of life [3]. The Brief Pain Inventory short form (SF-BPI) is the most widely used instrument and has the most number of foreign language translations [4].Objective To evaluate the prevalence of chronic pain, and intradialytic pain in patient undergoing haemodialysis, as well as the effectiveness of analgesic therapy. Methods Cross-sectional, descriptive and observational study. A random sample consisting of 172 patients undergoing haemodialysis in two clinics in the region of Lisbon, Portugal. The Brief Pain Inventory, which analyses the influence of pain in a patient’s life, was only applied to evaluate chronic pain [5]. The Visual Analogue Scale was used to assess the intradialytic pain. Tests were administered during dialysis sessions from May to June 2015. Categorical variables were expressed as percentages and continuous variables were expressed as mean standard deviations or medians. This study was approved by the Ethics Committee of Diaverum (N 1/2015). Results The sample consisted mostly of men (61.6%) of Portuguese nationality (80.7%), the mean age was 60 years (± 14.4), and patients were under haemodialysis treatment for 72.6 months (± 54.4). Chronic pain occurs in 54.1% of patients and intradialytic pain in 75%. The causes of pain were musculoskeletal (69.3%), associated to vascular access (19.3%) and other causes (11.4%). Chronic pain was most commonly located in the legs (43.2%), followed by back (21.6%) and vascular access (19.3), head (8%), arms (4.5%), abdomen (2.3%) and, lastly, chest (1.1%). The percentage of patients that took analgesics for chronic pain was much higher (62.0%), of these 87.8% are non-opiates, 10.2% weak opiates and 2% strong opiates. The other therapeutic interventions referred were: rest (24.1%), massage and relaxation (6.3%), cryotherapy (1.3%), exercise (1.3%), while 5.1% reported doing nothing. The effectiveness of the treatment was successful for chronic pain, in 62.6% of the patients, there was a relief felt of over 50%. Conclusions Pain of musculoskeletal origin is a frequent symptom in our sample. The pharmacological management of chronic pain is the most applied intervention.