Publication: Hemodiyaliz Hastalarında Ağrının Değerlendirilmesi
Abstract
Giriş ve amaç: Hoş olmayan duysal ve emosyonel bir tecrübe olan ağrı, kronik böbrek hastalığı (KBH) olan hastalarda yaygın bir semptomdur. Böbrek hastalarında primer ve eşlik eden hastalıklar, renal replasman tedavisi, farmakolojik tedaviler veya yan etkileri ağrıya neden olabilir, ağrı şiddeti hafiften şiddetliye kadar değişebilir. Hemodiyaliz hastalarının %50'den fazlasında ağrı görülmektedir ve ağrının klinisyenler tarafından tanınamaması nedeniyle ağrısı olan hastaların %75'i etkin şekilde tedavi edilememektedir. Ağrının ortaya çıkmasında çok sayıda durum ve patofizyolojik mekanizma ilişkilidir. Ancak kronik ağrının etkileri ve sonuçları sıklıkla gözden kaçmaktadır. Bu çalışmanın amacı hemodiyaliz hastalarında ağrı sıklığı, lokalizasyonu, süresi ve şiddetinin yanı sıra demografik, klinik özellikler ve laboratuvar sonuçları ile ağrı arasındaki ilişkinin değerlendirilmesidir. Gereç ve yöntem: Çalışmaya 202 hemodiyaliz hastası dahil edildi. Hastaların demografik bilgileri ve KBH ile ilişkili klinik özellikleri kaydedildi. Ağrı süresi, lokalizasyonu, şiddeti, tedavisi sorgulandı. Ağrının uyku üzerindeki etkisi değerlendirildi. Hemodiyaliz hastalarında semptom yükü Edmonton Semptom Değerlendirme Ölçeği (ESAS) ile, ağrı varlığı ve şiddeti ise McGill Ağrı Anketi ile (MGA) sorgulandı. Bulgular: Hastaların yaş ortalaması 59,6 ± 12,7 yıl idi (21-98 yaş). Hastaların % 40,1'i (n=81) kadın, % 59,9'u (n=121) erkekti. Hastaların % 80,2'sinde (n=162) ağrı mevcuttu. Hastaların % 71'inde (n=115) ağrı bir yıldan uzun süredir devam etmekteydi. % 34'ünde (n=55) ağrı her gün olmaktaydı. Ek olarak, hastaların % 37'sinde (n=60) ağrıyı uykuyu etkilemekteydi. Ağrının izlendiği en sık lokalizasyonlar alt ekstremite (% 61,1), üst ekstremite (% 35,8) ve bel (% 13) idi. Hastaların % 91,4'ü (n=148) ağrı için ilaç tedavisi kullanıyordu. En sık tercih edilen ajanlar ise sırasıyla parasetamol (% 56,8), pregabalin/gabapentin ( %25,9) ve steroid olmayan antiinflamatuar ilaçlar (SOAİİ) (% 21) idi. Hastaların median ESAS ve MGA skorları sırasıyla 20 (4-84 aralığında) ve 47 (22-84 aralığında) idi. Kadınlarda (p=0,001) ve eğitim seviyesi düşük olanlarda (p=0,005) ağrı sıklığı daha fazla idi. Ağrısı olan hastaların CRP (p=0,044) ve PTH (p=0,005) seviyeleri ve ESAS (p=0,001) skorları daha yüksekti. ESAS skoru kadınlarda (p=0,003), ağrının uykuyu iv etkilediği hastalarda (p<0,001) ve düzenli analjezik kullananlarda (p=0,002) daha yüksekti. MGA skorları eğitim seviyesi düşük olanlarda (p=0,022), diyabeti olanlarda (p=0,002), her gün ağrısı olanlarda (p<0,001) ve ağrının uykuyu etkilediği hastalarda (p<0,001) daha yüksekti. Ağrılı bölge sayısı fazla olan hastaların MGA skoru daha yüksekti (p<0,001). MGA skorları hastaların yaşı (p=0,001) ve ESAS skorları (p<0,001) ile koreleydi. Sonuç: Hemodiyaliz hastalarının çoğunda ağrı izlenmektedir. Cinsiyet ve eğitim seviyesi gibi çok sayıda faktör ağrı ile ilişkilidir. Ağrı hemodiyaliz hastalarının günlük yaşam aktivitelerini ve uykularını etkilemektedir. Anahtar Kelimeler: Hemodiyaliz, Ağrı, Ağrı şiddeti, Ağrı sıklığı
Introduction and aim: Pain is an unpleasant sensory and emotional experience and is common symptom experienced by patients with chronic kidney disease (CKD). It can be caused by primary co-morbid diseases, renal replacement therapies, medication or treatment side effects, and its intensity varies from mild to severe. 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 clinicians. A broad variety of conditions and different pathophysiological mechanisms are involved in pain manifestations. However, the impact of chronic pain and its consequences are often underestimated. The aim of this study was to evaluate the frequency, duration, severity, location of pain and to assess relationship between demographic, clinical and laboratory characteristics and pain in hemodialysis patients. Material and methods: Two hundred and two hemodialysis patients were included in the study. Demographic features of the patients and clinical features associated with CKD were obtained. Pain duration, location, severity, and treatment were asked. The effect of pain on sleep was evaluated. In hemodialysis patients, symptom burden and pain were evaluated by the Edmonton Symptom Assessment Scale (ESAS), and the McGill Pain Questionnaire (MPQ) scale, respectively. Results: The mean age of the patients was 59.6 ± 12.7 years (21-98 years). 40.1% (n=81) of the patients were female, 59.9% (n=121) were male. 80.2% of the patients (n=162) reported pain. Pain persisted for more than 1 year in 71% (n=115). 34% (n=55) had pain every day. Moreover, 37% of the patients (n=60) stated that pain affects sleep. The most common pain locations were lower extremity (61.1%), upper extremity (35.8%) and lower back (13.0%). 91.4% (n=148) of the patients were using drug therapy for pain. The most commonly preferred agents were paracetamol (56.8%), pregabalin/gabapentin (25.9%) and NSAID (21%), respectively. The median ESAS and MPQ score of the patients were 20 (range 4-84) and 47 (range 22- 84), respectively. The frequency of pain was higher in women (p=0.001) and patients with low education level (p=0.005). Patients with pain had higher C-reactive protein (p=0.044), parathyroid hormone levels (p=0.005) and ESAS scores (p=0.001). The ESAS score was higher in women (p=0.003), sleep affected by pain (p<0.001), and vi patients using analgesics regularly (p=0.002). The MPQ score was higher in those with low education level (p=0.022), diabetes (p=0.003), pain every day (p<0.001) and those whose pain affects sleep (p<0.001).MPQ score was higher in patients with more painful areas (p<0,001). MPQ score correlated with patients' age (p=0.001) and ESAS score (p<0.001). Conclusion: Pain is observed in the majority of hemodialysis patients. Numerous factors including gender and education level are associated with pain. Pain interferes with activities of daily living and sleep in hemodialysis patients. Key Words: Hemodialysis, Pain, Pain severity, Pain frequency
Introduction and aim: Pain is an unpleasant sensory and emotional experience and is common symptom experienced by patients with chronic kidney disease (CKD). It can be caused by primary co-morbid diseases, renal replacement therapies, medication or treatment side effects, and its intensity varies from mild to severe. 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 clinicians. A broad variety of conditions and different pathophysiological mechanisms are involved in pain manifestations. However, the impact of chronic pain and its consequences are often underestimated. The aim of this study was to evaluate the frequency, duration, severity, location of pain and to assess relationship between demographic, clinical and laboratory characteristics and pain in hemodialysis patients. Material and methods: Two hundred and two hemodialysis patients were included in the study. Demographic features of the patients and clinical features associated with CKD were obtained. Pain duration, location, severity, and treatment were asked. The effect of pain on sleep was evaluated. In hemodialysis patients, symptom burden and pain were evaluated by the Edmonton Symptom Assessment Scale (ESAS), and the McGill Pain Questionnaire (MPQ) scale, respectively. Results: The mean age of the patients was 59.6 ± 12.7 years (21-98 years). 40.1% (n=81) of the patients were female, 59.9% (n=121) were male. 80.2% of the patients (n=162) reported pain. Pain persisted for more than 1 year in 71% (n=115). 34% (n=55) had pain every day. Moreover, 37% of the patients (n=60) stated that pain affects sleep. The most common pain locations were lower extremity (61.1%), upper extremity (35.8%) and lower back (13.0%). 91.4% (n=148) of the patients were using drug therapy for pain. The most commonly preferred agents were paracetamol (56.8%), pregabalin/gabapentin (25.9%) and NSAID (21%), respectively. The median ESAS and MPQ score of the patients were 20 (range 4-84) and 47 (range 22- 84), respectively. The frequency of pain was higher in women (p=0.001) and patients with low education level (p=0.005). Patients with pain had higher C-reactive protein (p=0.044), parathyroid hormone levels (p=0.005) and ESAS scores (p=0.001). The ESAS score was higher in women (p=0.003), sleep affected by pain (p<0.001), and vi patients using analgesics regularly (p=0.002). The MPQ score was higher in those with low education level (p=0.022), diabetes (p=0.003), pain every day (p<0.001) and those whose pain affects sleep (p<0.001).MPQ score was higher in patients with more painful areas (p<0,001). MPQ score correlated with patients' age (p=0.001) and ESAS score (p<0.001). Conclusion: Pain is observed in the majority of hemodialysis patients. Numerous factors including gender and education level are associated with pain. Pain interferes with activities of daily living and sleep in hemodialysis patients. Key Words: Hemodialysis, Pain, Pain severity, Pain frequency
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