Pain Management For Chronic Kidney Disease Patients. Why Doctors Are Cutting Prescriptions?

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Pain is a serious and common issue in the Chronic Kidney Disease (CKD) community, especially those suffering with Ends Stage Renal Disease (ESRD). While the general population may suffer pain, only approximately 11%-24% of them battle chronic pain. On the other hand, 47% of dialysis patients suffer consistent chronic pain and a whopping 70% suffer some sort of severe acute pain. According to the Journal of American Society and Nephrology,  specific sources of pain are muscle pain (62%) followed by other organ systems including gastrointestinal (13%), genital (10%), blood diseases (10%), nervous system (9%), cardiovascular (7%) and others (10%). 

Recommended Reading: Can Chronic Kidney Disease Patients Reduce the Risk from Over-the -Counter Painkillers? 

Even with the astounding amount of pain that is pervasive in the ESRD community, KidneyBuzz.com has received several accounts of viewers finding it increasingly difficult to receive medication from their Nephrologists. " I've been taking Vicodin for the last year or so but now, for some unknown reason, my doctor has stopped prescribing them to me. I am suffering a lot of pain and I am miserable," one reader writes.

Recommended Reading: How those with Kidney Disease on Dialysis can manage Neuropathic Pain (NP) 

Well, an article published on Wednesday January 8th, 2014 by the Standard-Examiner suggests that things may be getting even "tighter." According to the article, starting Tuesday January 14th, 2014 tighter controls on how doctors can prescribe some of the most commonly used ESRD painkillers will take place. Also, manufacturers of pain relievers such as Benadryl,  Percocet, Hydrocodone Bitartrate, Vicodin and more (including generics) will be required to discontinue all prescription pain combination products that contain more than 325 mg. of acetaminophen (fever reducer and pain reliever). Typically these medications contain anywhere from 500mg. to 750mg. of acetaminophen. Hence, "if you're taking a pill that contains a greater amount, you won't be getting a refill after that date," suggests the Standard-Examiner. 

Recommended Reading: Significant Portion Of ESRD Patients Suffer Severe Pain: How To Control Without Fear Of Addiction 

The reason for the drastic change,  is to hopefully decrease the number of inadvertent acetaminophen overdoses that occur due to patients taking multiple products with acetaminophen in them, said Dustin Waters, McKay-Dee Hospital Pharmacist. The Food and Drug Administration's (FDA's) website notes that there is no data supporting substantially increased pain relief from taking more than 325mg of acetaminophen per dosage. "Under the new dosage limit, healthcare professionals can direct patients to take 1 or 2 tablets, capsules or other dosage units of a prescription product containing 325 mg of acetaminophen up to 6 times a day and still not exceed the maximum daily dose of acetaminophen," stated FDA.com. 

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ESRD patients should be reassured by the fact that Nephrologists still will abide by the same Pain Management Guidelines which requires both pharmacologic and non-pharmacologic approaches. The decision to prescribe a pain reliever will be based upon duration, cause, type and intensity of your pain. Thus, if you find that you need a pain reliever to maintain a high quality of life with little pain, then be very articulate and precise with your Nephrologists about your pain, and how it is affecting you directly. You are not begging for medication, rather you are attempting to find relief which ultimately will improve your overall health and life expectancy. 

Recommended Reading: New Treatment Set To Cut CKD Pill Burden And Significantly Improve Their Quality Of Life 

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References:

Lampros, Jamie. "Tighter Controls Coming for Pain-killer Prescriptions." Http://www.standard.net/. Standard-Examiner.

Phuong-Chi T. Pham1, Edgar Toscano1, Phuong-Mai T. Pham2, Phuong-Anh T. Pham3, Son V. Pham4 and Phuong-Thu T. Pham. "Clinical Kidney Journal." Http://ckj.oxfordjournals.org/. Pain Management in Patients with Chronic Kidney Disease.