Pain Reported by Patients Receiving Haemodialysis Treatment in Six London Dialysis Units

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DIALYSIS PATIENTS’ REPORTED SYMPTOMS – THE UNMET NEED FOR PAIN CONTROL

Afuwape S.A, Cross J., Alston H., Nitsch, D.,Davenport, A

Royal Free London NHS Foundation Trust

INTRODUCTION. Many symptoms associated with chronic kidney disease do not resolve following dialysis initiation, and as such symptoms including bodily pain are frequently reported among dialysis patients. Research indicates that many symptoms are not disclosed during routine medical assessment, adequate treatment is generally poor and consequently patients themselves accept pain and other symptoms as a part of their experience on dialysis.

METHODS. As part of a wider investigation into patients’ quality of life and experience on dialysis, 626 consenting patients in 6 North London satellite dialysis units, home haemodialysis and peritoneal dialysis patients were approached to complete a confidential on-the-spot questionnaire using the Kidney Disease Quality of Life Short Form (KDQUoL-SF) and other measures designed specifically for the study to explore the extent and impact of bodily pain in the preceding four weeks.

RESULTS. Of the 626 patients who were approached, 45% responded by completing a questionnaire. The largest proportion of respondents had been dialysing for between 1 and 4 years (43%) whilst 11% had been dialysing for 10 years or more. More than two-thirds (71%) of patients reported experiencing at least mild bodily pain in the previous week, which was significantly correlated with dialysing for more than 10 years (X2=5.65 p=0.017 df =1) with over half (56%) having experienced ‘moderate’, ‘severe’ or ‘very severe’ pain. Commonly experienced pain included muscle soreness, cramp and chest pain by which three-quarters of respondents were at least ‘somewhat bothered’. Experience of pain was also significantly correlated with a reduction in the amount of time spent on activities (X2=16.36 p<0.005df=1); accomplishing less than had desired (X2=14.68 p<0.005df=1); being limited in the kind of work performed (X2=15.75 p<0.005df=1) and having difficulty performing work and other activities (X2=32.91 p<0.005df=1). It was also correlated with the experience of low mood (X2=11.82 p=0.001df=1) and symptoms of anxiety (X2=7.28 p<0.05df=1) Despite this, more than half of those experiencing pain still rated their health as ‘good’, ‘very good’ or ‘excellent’.

CONCLUSIONS. Bodily pain is widely experienced by patients receiving dialysis treatment yet assessment and adequate treatment fail to be conducted routinely. Reduced activity and disability are associated with the experience of pain, yet patients consider their health to be ’good’ or ‘very good’ suggesting that adjustment to the pain experience becomes internalised and fails to contribute to their overall perception of what is considered to be good health. Routine assessment of and improved treatments for bodily pain are essential to help improve dialysis patients’ quality of life and reducing the extent of disability.