Pain in Maintenance Hemodialysis Patients: A Multicenter Study

Context. Pain is a common complaint in maintenance hemodialysis (MHD) patients yet is often inadequately assessed and undertreated. Objectives. The objective of this study was to evaluate the prevalence, characteristics, intensity, and impact of pain in MHD patients. Methods. In a cross-sectional study conducted between 2013 and 2015, 336 MHD patients from five hemodialysis units in hospitals owned by Clalit were interviewed and evaluated. Study tools included the Brief Pain Inventory, The Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale, and demographic and clinical characteristics. In addition, computerized pharmaceutical data were reviewed. Results. Pain was experienced by 82% of the study population (mean pain level: 7.2 +/- 2.2) in the 24-hour period before the interview, while 61.5% experienced neuropathic pain characteristics. Of patients with pain, two-thirds reported being regularly treated with pain medications, while 24.5% received nondrug pain treatment. Mean pain relief due to Brief Pain Inventory was 62.5 +/- 30%. In multivariate analysis, female gender, a high comorbidity index, and time on dialysis > 24 months were associated with the presence of significant pain in the previous 24 hours. In addition, severe pain report was associated with female gender, depression, $ 4 painful sites, and unemployment. Finally, neuropathic pain was associated with time on dialysis > 24 months, depression, $ 4 painful sites, and current intensity of pain > 2. Conclusion. Pain is common in MHD patients and is significantly associated with female gender, comorbidity, time on dialysis, and depression. Results of this study may serve as a starting point for palliative interventions for MHD patients. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.