| [ Summary ] |
Chronic pain is classified clinically as either nociceptive pain, neuropathic pain, or psychogenic pain. Neuropathic pain can be divided into peripheral neuropathic pain and central neuropathic pain. The Japanese Society for Dialysis Therapy recently reported that the leading reason for dialysis initiation in Japan is diabetic nephropathy. Therefore, many patients experience diabetic peripheral neuropathy or other causes of peripheral neuropathic pain such as dialysis-related amyloidosis. Non-steroidal anti-inflammatory drugs (NSAIDs) have been predominately administered to treat pain in patients undergoing dialysis ; however, there are numerous types of pain that are not sufficiently alleviated by NSAIDs, such as psychogenic pain and neuropathic pain. A woman in her 50s initiated hemodialysis in our hospital. Three months later, she developed chest pain during hemodialysis and was admitted to the coronary care unit. However, there was no significant coronary artery stenosis on angiography. Thereafter, chronic pain appeared in her left shoulder, chest, back, and extremities. She was diagnosed with myofascial pain complicated by psychogenic pain by a pain clinic physician. She was treated with exercise therapy, pain relievers, and cognitive behavioral therapy, and received care from a nephrologist, pain clinic physician, psychiatrist, pharmacist, and a certified chronic care nursing specialist. This is a report of a case of multidisciplinary care for general pain relief after the initiation of hemodialysis. |