A recent study published in AJKD looks at the epidemiology of chronic pain in US veterans and its impact on kidney disease and mortality. Dr Joline Chen (JC), co-author of the study headed by Dr. Kalantar-Zadeh, discusses the article with AJKD Blog editor Kenar Jhaveri (AJKDblog).
AJKDblog: Can you explain what the study showed?
JC: We set out to study the epidemiology of chronic pain and its impact on veterans’ health, specifically looking at the development of kidney disease. The Veteran Affairs (VA) has an ongoing campaign called Pain as the 5th Vital Sign. All veterans who visit VA clinics are asked to rate their pain from 0 to 10, with 0 being no pain and 10 being the worst pain experienced. Based on these scores, pain is then categorized to one of four levels: none, mild, moderate, or sever. In patients with normal kidney function, we found that those reporting moderate or severe pain have an 11% and 17% higher risk of rapid glomerular filtration rate loss, respectively, than those reporting no pain. Additionally, veterans reporting moderate or severe pain had a 30% higher risk of developing kidney disease or death compared to those with no pain.
AJKDblog: What are the most common reasons for pain in patients with CKD?
JC: The mechanism of pain is still very poorly understood, but there are a few hypotheses. Kidney disease patients often have cardiovascular disease, diabetes, hypertension, or rheumatologic disease as well. These patients are at high risk for ischemic pain, due to peripheral vascular disease or coronary artery disease, or neuropathic pain due to diabetes. These patients also may have higher sensitivity to pain.
AJKDblog: What were the limitations of the study, and how did they affect your results?
JC: Our study was limited by the lack of access to more granular data regarding the type and location of the pain. We also did not have details on analgesic medications obtained or consumed by veterans. In addition, our data comprised mostly male US veterans who are not representative of the country’s general population. However, our study sheds light on the epidemiology of pain and analgesic use among the US veterans and potential consequences of chronic pain using a long-term and comprehensive national database.
AJKDblog: What are your next steps? What questions came out of this study that you want to pursue?
JC: Our study focused on veterans without kidney disease. Veterans with kidney disease tend to have a high degree of pain. We are particularly interested in better understanding pain medication use in the broader context of other aspects of veterans’ health issues, including post-traumatic disorder, homelessness, and depression.
In addition, we would like to look closely at the pain and pain management of kidney disease patients. It would be interesting to study non-medicinal management in CKD patients, such as counseling for depression or exercise/acupuncture to alleviate pain.