Could emotional processing influence pain perception and quality of life in chronic kidney disease and hemodialyzed patients?

Background and Objectives: The incidence of chronic pain is 11-24% in general population, whereas it affects 50% of hemodialyzed subjects and is often secondary to comorbidities, CKD-related complications and certain clinical procedures. Consequently, a better approach in evaluating pain as a “symptom” and in managing it adequately is required for these patients. Methods: 33% of the 300 patients enrolled properly consigned the questionnaires. The mean age of dialyzed patients was 52.2±11.2 years, whereas 54.9±10.7 years was the mean age for CKD patients. Moreover, 53 healthy subjects, ages 20-65, have been included in the study as control group. Specific psycho-diagnostic tests were administered: EPI, ASQ, SF-36, REM-71, TAS-20, SCL-90. Results: We have observed that the mean values of quality of life and pain assessment tests for HD and CKD patients were lower than the control group on every dimension. Moreover, comparing the two nephropatic populations, HD patients were characterized by statistically significant lower values than CKD subjects, both for mental and physical dimensions. The SF36 human body graph highlighted that 17 out of 49 CKD patients suffered from severe pain, but only 3 of them were treated with analgesics (paracetamol and metamizole). In HD group, 38 patients reported severe pain and 30 of them were treated with analgesic drugs. Conclusions: Our data underlined that an introverted-psychotic personality trait, associated to an insecure and avoidant attachment style, closely and positively related to primitive defensive mechanisms, determined in nephropatic patients alterations of emotional processes of pain perception which is probably exacerbated by the worsening of the alexithymic status. For these reasons, the monitoring of expressive modalities of emotions must be performed regularly in both CKD and HD patients, through periodic administration of questionnaires and psychological support.