Chronic Pain is Prevalent Among Patients Receiving Maintenance Hemodialysis

It's not uncommon for patients undergoing maintenance hemodialysis (MHD) to experience chronic pain. The impact it has on their quality of life (QOL) is substantial.

Qian Rao, School of Nursing, Chengdu Medical College, and investigators sought to evaluate the prevalence of chronic pain in this population and examine the factors associated with quality of life.

The team found that chronic pain is prevalent and undermanaged in this patient population, leading to a decrease in quality of life. Based on these findings, healthcare providers should improve pain management and pay attention to the impact of psychological factors on patient quality of life.

The Motivation

The number of individuals with chronic kidney disease has been increasing in China, and the disease is recognized as a public health issue worldwide.

Renal replacement therapy is necessary for patients with stage 5 chronic kidney disease. Hemodialysis is the most utilized therapy as it can prolong the life of the patient.

However, hemodialysis is also accompanied by multiple symptoms, most commonly chronic pain presents in up to 82% of patients on maintenance hemodialysis.

Previous studies have indicated a relationship of poor quality of life among patients undergoing maintenance hemodialysis, and an even stronger connection with patients experienceing chronic pain.

As a multidimensional concept, many factors play a role in a patient's quality of life. Personal, environmental and socio-demographic aspects of a patient's life, along with clinical characteristics like primary disease and comorbidities, influence quality of life.

Investigators noted the importance of the psychosocial factors associated with quality of life, such as social support, self-efficacy, and depression. Few studies have explored the role of these factors, so this study aimed to identify the predictors of quality of life in this population and examine relationships among pain, self-efficacy, social support, and quality of life.

The Study

The multicenter, cross-sectional study took place from October 2020-April 2021. Maintenance hemodialysis patients who experienced chronic pain while undergoing treatment across 9 hospitals in Chengdu, China, were included in the research.

Patients came from various districts throughout Chengdu, which offered a wide geographic range represented in the investigation.

The diagnostic criteria for chronic pain according to the Internation Association for the Study of Pain (IASP) was used to determine patient eligibilty.

The critieria stated that pain had to occur daily or almost daily and had to last longer than 3 months. Also, the patient-reported score had to be equal to or great than 3 on a visual analog scale.

The Brief Pain inventory (BPI) was used to assess pain interference and severity, as well as pain location, treatments or medications received, and the degree of pain relief 24 hours post-treatment or medication.

Quality of life was assessed with the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), which has been deployed worldwide to examine quality of life in various population types.

Additionally, the Pain Self-Efficacy Questionnaire and the Social Support Rating Scale were completed by participating patients for a comprehensive profile.

The Results

Of the 1204 patients who were participating in treatment at any of the 9 study sites, a total of 296 patients were eligible and willing to be included in the research.

The study consisted mostly of patients who were 60 years of age or older (60.8%) with an age range of 27–93 years. Many were married (83.1%), had completed a junior high School education or below (74.3%), were not currently employed (97%), and reported financial strain (84.5%).

The SF-36, used to assess quality of life, is made of two subscales: the Mental Component Summary (MCS) and the Physical Component Summary (PCS).

"We found that age, employment status, financial strain, and number of comorbidities were significantly associated with MCS, PCS, and pain self-efficacy scores (p < 0.05)," investigators wrote.

Predictors of quality of life were identified using stepwise multiple linear regression, as measured in terms of MCS and PCS scores.

"The independent predictors of MCS score were age (p = 0.004), financial strain (p = 0.001), pain interference (p < 0.001), social support (p = 0.023), and pain self-efficacy (p < 0.001). These variables accounted for 57.3% of the variance in MCS scores (adjusted R2 = 0.573)," investigators stated.

Only 26.7% (322) of the total 1204 patients on maintenance hemodialysis in this study reported chronic pain. The pain severity score was 3.6 (IQR 3-4.6) and the pain interference score was 4 (IQR 3-5), with the duration of chronic pain being reported as 5 years (IQR 1-7 years).

"Based on the results of this study, we put forward the following suggestions," investigators wrote.

"First, medical staff should pay more attention to the assessment and management of chronic pain among MHD patients. Appropriate pain management strategies are essential to meet the needs of this patient population."

"Second, the influence of psychosocial factors on MHD patients should be researched in detail. Social support and pain self-efficacy play important roles in improving the QOL of MHD patients with chronic pain."

"Psychological therapies such as health education, cognitive behavioral therapy, supportive psychotherapy and mindfulness therapy may be useful for improving pain self-efficacy and social support," investigators concluded.

The study, "Chronic Pain and Quality of Life in Maintenance Hemodialysis Patients in China: A Multicenter, Cross-Sectional Study" was published in the Journal of Pain Research.