Multidisciplinary management of chronic refractory pain in autosomal dominant polycystic kidney disease

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2023-02, Vol.38 (3), p.618-629
• Main Authors: van Luijk, Franka, Gansevoort, Ron T, Blokzijl, Hans, Groen, Gerbrand J, de Haas, Robbert J, Leliveld, Anna M, Meijer, Esther, Perdok, Joke M, Stellema, Ruud, Wolff, Andreas P, Casteleijn, Niek F
• Format: Article
• Language: English
• Subjects: Adult; Chronic Pain - therapy; Cysts; Female; Humans; Male; Middle Aged; Nephrectomy; Original; Pain, Intractable - surgery; Polycystic Kidney, Autosomal Dominant; Quality of Life
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfac158

ABSTRACT Background Chronic pain is often difficult to manage in autosomal dominant polycystic kidney disease (ADPKD) patients and sometimes even leads to nephrectomy. We analyzed the long-term efficacy of our innovative multidisciplinary protocol to treat chronic refractory pain that aims to preserve kidney function by applying among other sequential nerve blocks. Methods Patients were eligible if pain was present ≥3 months with a score of ≥50 on a visual analog scale (VAS) of 100, was negatively affecting quality of life and if there had been insufficient response to previous therapies, including opioid treatment. Treatment options were, in order, analgesics, cyst aspiration and fenestration, nerve blocks and nephrectomy. Results A total of 101 patients were assessed in our clinic (mean age 50 ± 11 years, 65.3% females). Eight patients were treated with medication, 6 by cyst aspiration or fenestration, 63 by nerve blocks and 6 received surgery as the first treatment option. Overall, 76.9% experienced a positive effect on pain complaints shortly after treatment. The VAS score was reduced from 60/100 to 20/100 (P