In autosomal dominant polycystic kidney disease (ADPKD), persistent flank, abdominal, or back pain believed to be related to the kidneys is a recognised complication. When initial nonpharmacologic measures have not controlled this pain adequately, a structured pharmacologic approach is indicated.
This protocol addresses people with ADPKD experiencing chronic kidney pain — flank, abdominal, or back pain thought to be kidney-related and lasting longer than 3 months — whose pain has not been adequately relieved by nonpharmacologic, noninvasive interventions.
The preceding step — nonpharmacologic, noninvasive interventions as initial management of chronic kidney pain — did not achieve the target of adequate pain relief. That unmet goal is the clinical trigger for the pharmacologic protocol described here.
The next step involves a stepwise pharmacologic analgesic strategy. A specific first-line oral analgesic is recommended, and there are defined adjuvant options for patients who need additional support. The complete agent selection, sequencing, and clinical decision criteria are available in the full protocol.
Adequate relief of chronic kidney pain.
Chronic kidney pain in ADPKD is defined as flank, abdominal, or back pain that is thought to be related to the kidneys and lasts longer than 3 months.
Stepwise pharmacologic treatment for chronic kidney pain in people with ADPKD should be implemented when nonpharmacologic, noninvasive interventions do not adequately relieve pain.
Acetaminophen is the first-line drug for chronic pain control.
Tricyclic antidepressants and gabapentin also may be useful as analgesic adjuvants, despite the lack of RCTs in ADPKD.
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