Emerging Patient-Centered Concepts in Pain Among Adults With Chronic Kidney Disease, Maintenance Dialysis, and Kidney Transplant.
Emerging Patient-Centered Concepts in Pain Among Adults With Chronic Kidney Disease, Maintenance Dialysis, and Kidney Transplant.
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DOI：
10.1016/j.semnephrol.2021.10.007
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发表时间：
2021-11
影响因子：
3.3
通讯作者：
Fischer MJ
中科院分区：
文献类型：
--
作者：
Lockwood MB;Steel JL;Doorenbos AZ;Contreras BN;Fischer MJ
中度至重度疼痛的患者报告在各种慢性肾脏疾病中都很常见。共病抑郁和焦虑的协同作用可能导致对疼痛的适应不良反应，即疼痛灾难化和与疾病相关的创伤后应激障碍。如果不治疗潜在的抑郁和焦虑以及相关的适应不良应对反应，患者可能会经历疼痛感增加、残疾恶化、生活质量下降、退出社交活动以及发病率和死亡率增加。与此同时，人们对针对应对疼痛以及共病焦虑和抑郁的非药物治疗的兴趣不断增长，特别是考虑到阿片类药物流行造成的重大社会损害。基于证据的非药物治疗在治疗肾病学以外领域的疼痛方面已显示出前景。目前，人们对这些治疗方法对慢性肾病成人患者的影响知之甚少，特别是对终末期肾病患者，慢性疼痛会使人衰弱。在这篇综述中，我们研究了与疼痛相关的以患者为中心的概念，这些概念在肾脏病学文献中很少受到关注。我们还描述了新兴的研究领域，包括用于生物标志物发现的组学技术和用于症状表型分析的先进症状聚类方法，这可能对未来的肾脏疾病研究和治疗有用。
Patient reports of moderate to severe pain are common across the spectrum of chronic kidney disease. The synergistic effects of comorbid depression and anxiety can lead to maladaptive coping responses to pain, namely pain catastrophizing and illness-related post-traumatic stress disorder. If underlying depression and anxiety and associated maladaptive coping responses are not treated, patients can experience increased perception of pain, worsened disability, decreased quality of life, withdrawal from social activities, and increased morbidity and mortality. Meanwhile, interest in nonpharmacological treatments for pain that targets coping as well as comorbid anxiety and depression has been growing, particularly given the significant societal damage that has resulted from the opioid epidemic. Evidence--based, nonpharmacological treatments have shown promise in treating pain in areas outside of nephrology. Currently, little is known about these treatments’ effects among adults with CKD, and particularly end-stage kidney disease, when chronic pain can become debilitating. In this review, we examine patient-centered concepts related to pain that have received little attention in the nephrology literature. We also describe emerging areas of research, including omics technologies for biomarker discovery and advanced symptom clustering methods for symptom phenotyping, that may be useful to future kidney disease research and treatment.
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