Pharmacological pain management in patients with chronic kidney disease

Chronic kidney disease (CKD) is one of the most frequently seen comorbidities in patients suffering from musculoskeletal conditions; it is defined by a glomerular filtration rate (GFR) under 60 ml/min/1.73 m2. The following paper focuses on providing a dosage adjustment guideline depending on how advanced renal impairment is. A literature search was carried out using the following items: pharmacokinetics, side effects, drug interactions and dosage, pain medication and antirheumatic drugs in renal failure. The use of non-steroidal anti-inflammatory drugs is inadvisable for a GFR < 30 ml/min as they all pose the risk of inducing acute renal damage, as well as worsening of the underlying chronic renal disease. Non-steroidal antiinflammatory drugs (NSAIDs) should be avoided due to the possibility of kidney disease progression. Paracetamol is an analgesic often chosen in this category of patients. As far as opioid analgesics are concerned, methadone is the only one that can be used without dosage adjustment. Physiotherapy remains a good and safe option for treatment in patients with musculoskeletal complaints. The use of analgesics in patients with CKD continues to be a challenge, as more research is needed.