Opioid Use in Chronic Pain Patients with Chronic Kidney Disease: A Systematic Review

• Published in: Pain medicine (Malden, Mass.) Vol. 18; no. 8; pp. 1416 - 1449
• Main Authors: Nagar, Vittal R., Birthi, Pravardhan, Salles, Sara, Sloan, Paul A.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-08-2017
• Subjects: Analgesics; Analgesics, Opioid - therapeutic use; Chronic pain; Chronic Pain - drug therapy; Chronic Pain - epidemiology; Chronic Pain - etiology; Clinical trials; Evidence-based medicine; Humans; Kidney diseases; Narcotics; Opioids; Pain; Prevalence; Quality control; Renal Insufficiency, Chronic - complications; Systematic review; Chronic Kidney Disease; Dialysis; End-Stage Renal Disease; Chronic Opioid Therapy; Opioids; Chronic Pain
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnw238

Abstract
Objectives. To investigate the prevalence of chronic pain and opioid management among patients with chronic kidney disease (CKD).
Design. Systematic review.
Methods. A systematic search was performed, including citations from 1960 to May 2015. The review highlights methodological quality assessment of the selected studies; prevalence of pain; type, dose, and reason for opioid use; effectiveness of pain control and associated adverse effects of opioids in CKD patients.
Results. Twelve of 131 articles met inclusion criteria. There were no randomized controlled trials (RCT) evaluable, and 12 were observational studies. Out of 12 studies, four were of high quality, six were of moderate quality, and the remaining two were low-quality studies. The studies were from different countries with sample size ranging from 10 to 12,782. Several studies showed a high prevalence of chronic uncontrolled pain. The effectiveness of different categories of opioids, dose, duration, and commonly prescribed opioids varied across studies.
Conclusions. Based on a systematic review of the current literature, there is fair evidence for the high prevalence of chronic pain among patients with CKD, which is not being effectively managed, probably due to underprescription of analgesics or opioids in the CKD population. Clinicians are in need of additional and well-designed randomized control trials that focus on the indications for opioid therapy, appropriate opioid doses and dosing intervals, outcomes with adequacy of symptom control, and reporting on the incidence of adverse side effects.