The Curbsiders Internal Medicine Podcast #146 NephMadness: Pain Meds in Chronic Kidney Disease
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Apr 1, 2019 Explore the complexities of pain management in chronic kidney disease (CKD), including the risks and benefits of opioids, gabapentin, tramadol, and NSAIDs. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in CKD is discussed, along with alternative options like topical NSAIDs. Discover pain management options for neuropathy and arthritis, and hear predictions and analysis of various pain meds in the NephMadness tournament.
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Opioid Dependence Can Mimic Benefit
- Benefits and harms of pain meds can blur over time, especially with opioids.
- Dependence can mimic benefit, leading patients to believe opioids still help when they mainly avoid withdrawal symptoms.
Avoid Toxic Opioids in CKD
- Avoid morphine, codeine, and meperidine in CKD due to toxic metabolites.
- Use hydromorphone cautiously and educate clinicians about renally cleared drugs to prevent harm.
Buprenorphine Is Underused in CKD
- Buprenorphine patch is a safe opioid option in CKD but is underused due to regulatory restrictions in the US.
- Buprenorphine reduces opioid harms and helps patients taper off high-dose opioids.