Management of pain in end ‐stage renal disease patients: Short review

Abstract Pain management in end stage renal disease (ESRD) patients is a complex and challenging task to accomplish, and effective pain and symptom control improves quality of life. Pain is prevalent in more than 50% of hemodialysis patients and up to 75% of these patients are treated ineffectively due to its poor recognition by providers. A good history for PQRST factors and intensity assessment using visual analog scale are the initial steps in the management of pain followed by involvement of palliative care, patient and family counseling, discussion of treatment options, and correction of reversible causes. First line should be conservative management such as exercise, massage, heat/cold therapy, acupuncture, meditation, distraction, music therapy, and cognitive behavioral therapy. Analgesics are introduced according to WHO guidelines (by the mouth, by the clock, by the ladder, for the individual, and attention to detail) using three‐step analgesic ladder model. Neuropathic pain can be controlled by gabapentin and pregabalin. Substitution/addition of opioid analgesics are indicated if pain control is not optimal. Commonly used opioids in ESRD patients are tramadol, oxycodone, hydromorphone, fentanyl, methadone, and buprenorphine. Methadone, fentanyl, and buprenorphine are the ideal analgesics in ESRD. However, complex pain syndrome requires multidrug analgesic regimen comprising opioids, non‐opioids, and adjuvant medication, which should be individualized to the patie...
Source: Hemodialysis International - Category: Hematology Authors: Tags: Review Article Source Type: research

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Source: Journal of Pain and Symptom Management - Category: Palliative Care Source Type: research
Source: Journal of Pain and Symptom Management - Category: Palliative Care Source Type: research
Conclusions: Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction. PMID: 31006184 [PubMed - as supplied by publisher]
Source: Archives of Plastic Surgery - Category: Cosmetic Surgery Tags: Arch Plast Surg Source Type: research
We describe a case of a patient with severe intellectual disability and an open fracture of the distal lower limb. After fracture management and debridement of devitalized tissues, the resultant soft tissue defect was covered with a free gracilis flap. On postoperative day 7, the patient ripped out the newly transplanted flap. The flap was too traumatized for salvage, so a contralateral free gracilis muscle flap was used. The patient showed good aesthetic and functional outcomes at a 1-year follow-up. When planning the postoperative management of patients with psychiatric illness, less complex and more robust procedures ma...
Source: Archives of Plastic Surgery - Category: Cosmetic Surgery Tags: Arch Plast Surg Source Type: research
Abstract BACKGROUND: While multifraction radiotherapy (RT) regimens (MFRT) have been considered the standard of care in patients with metastatic epidural spinal cord compression (MESCC) with limited prognosis, recent randomized evidence has demonstrated that single fraction RT (SFRT) may be equivalent in terms of functional and overall outcomes. A systematic review and meta-analysis was conducted to determine the effects of SFRT compared to short course MFRT in patients with MESCC. METHODS: A search of OVID, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to February 2018 was con...
Source: Radiotherapy and Oncology : journal of the European Society for Therapeutic Radiology and Oncology - Category: Radiology Authors: Tags: Radiother Oncol Source Type: research
One night, a woman I ’ll call Tonya got a compliment from a guy when she was out with her boyfriend. Tonya’s boyfriend cursed her because another man had complimented her. He said: “You give it to everybody, I want it too.” In anticipation of his physical abuse, she reasoned, “I could go off to Wonder […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Medications Pain Management Source Type: blogs
Publication date: Available online 21 April 2019Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Saber Davide Barbar, Laurent Muller, Vincent Brucker, Marc Leone, Mervyn Singer
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 21 April 2019Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Souhayl Dahmani, Vincent Laudenbach
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
van Ilioara Oniga Several Ajuga species are used in Romanian folk medicine for their antioxidant, antimicrobial and anti-inflammatory properties, to treat pain, fever or arthritis. Still, the active compounds responsible for these effects and their mechanism of action are scarcely known. This research was designed to investigate the phytochemical profile (e.g. iridoids, polyphenolic compounds, phytosterols), as well as the biological potential (antioxidant, antibacterial, antifungal, anti-inflammatory properties) of two selected Ajuga species collected from different regions of Romanian spontaneous flora. The main co...
Source: Molecules - Category: Chemistry Authors: Tags: Article Source Type: research
NEW YORK (Reuters Health)—How parents and children reminisce about the child’s recent surgery affects the child’s pain memory, researchers from Canada report. Children who recall pain that is higher than initially reported are more likely to report more pain and distress during future pain experiences. These negatively biased memories, formed early in life, set the... [Read More]
Source: The Rheumatologist - Category: Rheumatology Authors: Tags: Conditions juvenile surgery pain memories parent-child reminiscing pediatric pain management Source Type: research
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