{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:41:12Z","timestamp":1791283272611,"version":"4.1.0"},"reference-count":46,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,12,11]],"date-time":"2017-12-11T00:00:00Z","timestamp":1512950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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\u2010step 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\u2010opioids, and adjuvant medication, which should be individualized to the patient to achieve adequate pain control.<\/jats:p>","DOI":"10.1111\/hdi.12622","type":"journal-article","created":{"date-parts":[[2017,12,11]],"date-time":"2017-12-11T14:56:38Z","timestamp":1513004198000},"page":"290-296","source":"Crossref","is-referenced-by-count":42,"title":["Management of pain in end\u2010stage renal disease patients: Short review"],"prefix":"10.1111","volume":"22","author":[{"given":"Rupesh","family":"Raina","sequence":"first","affiliation":[{"name":"Department of Nephrology Cleveland Clinic Akron General\/Akron Nephrology Associates Akron Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinod","family":"Krishnappa","sequence":"additional","affiliation":[{"name":"Department of Nephrology Cleveland Clinic Akron General\/Akron Nephrology Associates Akron Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Hospice and Palliative Medicine University Hospitals Cleveland Medical Center Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,12,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2003.08.025"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.12066"},{"key":"e_1_2_8_4_1","unstructured":"International association for the study of pain. 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