Chronic Neuropathic Pain in ESRF Patient

• Neuropathic pain is defined as pain arising as a direct consequence of a lesion or a disease affecting the somatosensory system. Neuropathic pain is often described  as tingling, numbing, burning and/or stabbing.
• It is a challenge to manage pain in patient with renal insufficiency since the pharmacokinetic properties of most pain medications including their distrbution, clearance and excretion is altered. 

Treatment algorithm of neuropathic pain in ESRF patient

 

• Alternatively another guideline recommends the use of topical lidocaine, tricyclic antidepressants (TCAs),rec gabapentinoids (gabapentin and pregabalin), and selective noradrenergic reuptake inhibitors (SNRIs; duloxetine and venlafaxine) as the first-line choices in trearment of neuropathic pain.

Dose adjustment for agents used in neuropathic pain for ESRF patient. 

References : 

1.  http://www.the-rheumatologist.org/article/how-to-manage-pain-in-patients-with-renal-insufficiency-or-end-stage-renal-disease-on-dialysis/?singlepage=1
2. http://www.uptodate.com
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844009/