Implications for further research - Assessment and management of pain in patients on renal repl

The findings of the present research appear to indicate a need for more detailed study of pain experienced by Chronic Kidney Disease patients throughout the various stages of the disease as well as after transplantation. In addition, further research is required to investigate the knowledge and attitudes of renal nurses towards their patients’ pain experiences, as this aspect of the daily interactions between nurses and patients was not studied in the present study. Finally, there is a need for detailed research into general population pain perception and experience compared to these of pre-dialysis and dialysis patients.

13 Conlusion and Implications

According to the results of the present dissertation, renal patients on Haemodialysis and Peritoneal Dialysis experience equally high levels of pain due to the nature of their disease or painfull interventions, such as vascular access cannulation or insertion of peritoneal dialysis catheter. Pain levels showed a tendency to increase as the age of the patients progressed and in male participant’s pain had been affecting more bodily parts than in females. In conclusion, both groups of patients used similar ways to self-manage pain, despite the different areas where the pain focused.

As it was discussed earlier, multidisciplinary approach to Chronic Kidney Disease patients and collaborative management with maximal usage of available resources is necessary in order to meet the individual’s health needs. A more technical care aiming only at clinical outcomes of renal patients should be avoided. Instead, individually tailored and evidence-based interventions within the nursing care plan should be implemented to improve, on the one hand, patient’s outcomes and satisfaction, and decrease hospitalisation, but also provide high quality care for their psychosocial and emotional concerns. Dialysis patients in pain should be identified early and provided care by multidisciplinary teams that will evolve the patients themselves in the management approach choosen. To achieve this target, healthcare professionals should be more educated and trained in pain management, in order to define the aetiology of pain, as early as possible. This can help them to choose from a cascade of treatments, pharmacological or complementary, aiming at maintaining the quality of life of dialysis population and support their self-care. In addition, patients will be involved in decision making, adapting to their illness more easy and in a way that they preserve balance while passing from their previous lives to the new present, and to future.

13.1 CLINICAL IMPLICATIONS

The most important step in caring for a patient with Chronic Kidney Disease and in pain is to non-judgmentally listen to him/her and assess the magnitude and significance of pain. As it has been proven, that pain is a personal experience and it cannot be accurately measured, eventhough there are numerous pain rating scales and tools. So, during the therapeutic process, understanding, communicating and feeling empathy for his/hers situation can be helpful, towards managing pain. It should be bore in mind that adequate pain management is both a human beings’ basic need as well as basic right. The fundamental goal of pain management is to have the patient as comfortable as possible and to help him/her to adapt to the new reality through psychobehavioural interventions, respecting any cultural or religious diversity. Preconceived notions about the patients’ behaviours or attitudes should be avoided in order for nurses to make unprejudiced decisions regarding patient care.

It is mandatory for national and international organisations/associations to develop guidelines or treatment algorithms for pain management in Chronic Kidney Disease.

Clinicians could use the specific algorithms in order to provide adequate pain management in combination with their already acquired knowledge on pharmacology (Meechan et al.

2011). Focus on pain assessment and management will likely have a positive affect to health-related quality of life in renal patients. As healers, nurses need to take advantage of the appropriate and efficient interventions to promote healing.

13.2 IMPLICATIONS FOR FURTHER RESEARCH

References

Ackerman CJ & Turkoski B. 2000. Using guided imagery to reduce pain and anxiety.

Journal of Healthcare Nurse 18, 524-530.

Act of patients’ rights. 1992. Law 2071/1992, Greek Government Paper (FEK) 123, volume 92, paragraph 47.

Agarwal R & Sinha AD. 2009. Cardiovascular protection with antihypertensive drugs in dialysis patients: systematic review and meta-analysis. Hypertension 53, 860-866.

Aghabati N, Mohammadi E & Pour Esmaiel Z. 2010. The effect of therapeutic touch on pain and fatigue of cancer patients undergoing chemotherapy. Evidence Based Complementary and Alternative Medicine 7, 375-381.

Aitken E, McLellan A, Glen S, Serpell M, Mactier R & Clancy M. 2013. Pain resulting from arteriovenous fistulae: prevalence and impact. Clinical Nephrology 80, 328-333.

Aitken R. Measurement of feelings using visual analogue scales. 1969. Proceedings of Renal Society of Medicine 62, 989-993.

Aldridge MD & Meier DE. 2013. It is possible: Quality measurement during serious illness.

JAMA Internal Medicine 173. 2080-2081.

Alhani F, Shad H, Anoosheb M & Hajizadeh E. 2010. Programmed distraction on the pain caused by venipuncture among adolescents on Hemodialysis. Pain Management Nursing 11, 85-91.

Andrade SV, Sesso R & Diniz DH. 2015. Hopelessness, suicide ideation, and depression in chronic kidney disease patients on haemodialysis or transplant recipients. Journal of Brazilian Nefrology 37, 55-63.

Andreucci VE, Fissell RB, Bragg-Gresham JL, Ethier J, Greenwood R, Pauly M, Wizemann V

& Port FK. 2004. Dialysis Outcomes and Pracitce Patterns Study (DOPPS) Data on Medications in Haemodialysis Patients. American Journal of Kidney Diseases 44, S61-S67 Angst MS, Buhrer M & Lotsch J. 2000. Insidious intoxication after morphine treatment in

renal failure: delayed onset of morphine-6-glucuronide action. Anaesthesiolgy 92, 1473-1476.

Anthony D. 1999. Understanding Advanced Statistics. Churchill Livingstone, Edinburgh, UK 42-43..

Atalay H, Solak Y, Biyik M, Biyik Z, Yeksan M, Uguz F, Guney I, Tonbul HZ, Turk S. 2010.

Sertraline treatment is associated with an improvement in depression and health-related quality of life in chronic peritoneal dialysis patients. International Journal of Urology &

Nephrology 42, 527-536.

Atalay H, Solak Y, Biyik Z, Gaipov A, Guney F & Turk S. 2013. Cross-over, open-label trial of the effects of gabapentin versus pregabalin on painful peripheral neuropathy and health-related quality of life in haemodialysis patients. Clinical drug Investigation 33, 401-408.

Azevedo LF, Costa-Pereira A, Mendonc L, Dias CC & Castro-Lopes JM. 2016. The economic impact of chronic pain: a nationwide population-based cost-of-illness study in Portugal.

European Journal of Health Economy 17, 87-98.

Badani KK, Hemal AK & Menon M. 2004. Autosomal dominant polycystic kidney disease and pain – a review of the disease from aetiology, evaluation, past surgical treatment options to current practice. Journal of Postgraduate Medicine 50, 222-226.

Bae KT, Zhu F, Chapman AB, Torres VE, Grantham JJ, Guay-Woodford LM, Baumgarten DA, King BF, Wetzel LH, Kenney PJ, Brummer ME, Bennett WM, Klahr S, Meyers CM, Zhang X, Thompson PA & Miller JP for the Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP). 2006. Magnetic resonance imaging evaluation of hepatic cysts in early autosomal-dominant polycystic kidney disease: the Consortium for

Radiologic Imaging Studies of Polycystic Kidney Disease cohort. Clinical Journal of the American Society of Nephrology 1, 64-69.

Bagheri-Nesami M, Espahbodi F, Nikkhah A, Shorofi SA & Charati JY. 2014. The effects of lavender aromatotherapy on pain following needle insertion into a fistula in haemodialysis patients. Complementary Therapy Clinical Practice 20, 1-4

Bailie G, Mason N, Bragg-Gresham J, Gillespie B & Young E. 2004. Analgesic prescription patterns among haemodialysis patients in the DOPPS: Potential for underprescription.

Kidney International 65, 2419-2425.

Bailie G, Eisele G, Liu L, Roys E, Kiser M, Finkelstein F, Wolfe R, Port F, Burrows-Hudson S

& Saran R. 2005. Patterns of medication use in the RRI-CKD study: focus on medications with cardiovascular effects. Nephrology, Dialysis and Transplantation 20, 1110-1115.

Bajwa ZH, Gupta S, Warfield CA & Steinman TI. 2001. Pain management in polycystic kidney disease. Kidney International 60, 1631-1644.

Bajwa ZH, Sial KA, Malik AB & Steinman TI. 2004. Pain patterns in patients with Polycystic Kidney Disease. Kidney International 66, 1561-1569.

Barakzoy AJ & Moss AH. 2006. Efficacy of the World Health Organisation analgesic ladder to treat pain in End-Stage Renal Disease. Journal of American Society of Nephrology 17, 3198-3203.

Barnung SK, Treschow M & Borgbjerg FM. 1997. Respiratory depression following oral tramadol in a patient with impaired renal function. Pain 71, 111-112.

Barry PJ, Gallagher P, Ryan C & O’Mahony D. 2007. START (screening tool to alert doctors to the right treatment)-an evidence-based screening tool to detect prescribing omissions in elderly patients. Age and Ageing 36, 632-638.

Bartley EJ & Fillingim RB. 2013. Sex differences in pain: a brief review of clinical and experimental findings. British Journal of Anaesthesia 111, 52-58.

Bassillios N, Launay-Vacher V, Khoury N, Rondeau E, Deray G, Sraer JD. 2001. Gabapentin neurotoxicity in a chronic haemodialysis patient. Nephrology, Dialysis and Transplantation 16, 2112-2113.

Baykan H & Yargic I. 2012. Depression, anxiety disorders, quality of life and stress coping strategies in haemodialysis and continuous ambulatory peritoneal dialysis patients.

Journal of Clinical Psychopharmacology 22, 167-176.

Beijer HJ & Blaey CJ. 2002. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharmacology World Science 24, 46-54.

Bellieni CV, Cordelli DM, Raffaelli M, Ricci B, Morgese G & Buonocore G. 2006. Analgesic effect of watching TV during venepuncture. Archives of Disease in Childhood 91, 1015-1017.

Bennett M. 2001. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 92, 147-157.

Benini F, Gobber D, Lago P, Agosto C, Carli G & Zacchello F. 1998. Pain management of arteriovenous fistula cannulation in haemodialysis children: efficacy of EMLA anaesthetic cream. European journal of pain 2, 109-113.

Binik YM, Baker AG, Kalogeropoulos D, Devins GM, Guttmann RD, Hollomby DJ, Barre PE, Hutchison T, Prud’Homme M & McMullen L. 1982. Pain, control over treatment, and compliance in dialysis and transplant patients. Kidney International 21, 840-848.

Binns-Turner PG, Wilson LL, Pryor ER, Boyd GL & Prickett CA. 2011. Perioperative music and its effects on anxiety, haemodynamics and pain in women undergoing mastectomy.

American Association of Nurse Anaesthetists Journal 79, S21-S27.

Bolesta S & Haber SL. 2002. Hepatotoxicity associated with chronic acetaminophen administration in patients without risk factors. Annual Pharmacotherapy 36, 331-333.

Borbasi S, Jackson D & Langford R. 2004. Navigating the maze of nursing research: an interactive learning adventure. Marrickville, NSW: Elsevier Australia.

Borneman T & Ferrell BR. 1996. Ethical issues in pain management. Clinics of Geriatric Medicine 12, 615-628.

Bower S. 1982. Plasma protein binding of fentanyl: the effect of hyperlipoproteinemia and