**Author details**

Ahmed Zaghw1 \*, Mohamed Koronfel2 , Edward Podgorski3 , Sara Siddiqui1 , Arif Valliani1 , Arunabha Karmakar1 and Jaffar Khan1

\*Address all correspondence to: azaghw@hamad.qa

1 Hamad General Hospital, Weill Cornell University, Doha, Qatar

2 Cleveland Clinic, Cleveland, Ohio, USA

3 Jackson Memorial Hospital, University of Miami, Miami, Florida, USA

#### **References**


[7] Marshall SA, Ng L, Unemori EN, Girling JE, Parry LJ. Relaxin deficiency results in increased expression of angiogenesis- and remodelling-related genes in the uterus of early pregnant mice but does not affect endometrial angiogenesis prior to implantation. Reproductive Biology and Endocrinology. 2016 Mar 22;**14**(1):11

as sertraline and amitriptyline can be used for chronic pain with the appropriate indications.

Special thanks for Dr. Raval Chetankumar, assistant professor of Clinical Anesthesiology at Weill Cornell University, Qatar and Dr. Brahim Boudjenah, senior anesthesia specialist in Hamad Medical Corporation, Qatar for their valuable comments, chapter editing, and

, Edward Podgorski3

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, Sara Siddiqui1

, Arif Valliani1

,

reviewing. The publication of this article was funded by the Qatar National Library.

Sumatriptan is safe to use in pregnant patients with migraine.

\*, Mohamed Koronfel2

\*Address all correspondence to: azaghw@hamad.qa

2 Cleveland Clinic, Cleveland, Ohio, USA

and Jaffar Khan1

1 Hamad General Hospital, Weill Cornell University, Doha, Qatar

3 Jackson Memorial Hospital, University of Miami, Miami, Florida, USA

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Ahmed Zaghw1

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**Chapter 6**

**Provisional chapter**

**Pain Management in Patients with Impaired Kidney**

**Pain Management in Patients with Impaired Kidney** 

Huge numbers of patients referred to pain service have kidney function impairment to some extent. Pain physicians face puzzling cases and may find themselves struggling and divided between the decisions of providing adequate pain reliever, at the same time avoiding further damage to kidneys, and excessive accumulation of medications and their metabolites, also negative interactions with patient's other medications. In this chapter, we will reason about the prevalence of pain in patients with renal impairment, pharmacodynamics and pharmacokinetics of pain medications in this group, optimization of pain control, preferred choice of drugs according to the level of kidney damage,

**Keywords:** impaired kidney function (IKF), chronic kidney disease (CKD), acute pain,

Across all subspecialties, pain is the most encountered problem. It is particularly difficult to deal with in patients with organ dysfunction such as acute or chronic kidney failure, due to the fact that most medications depend on kidneys for clearance. Moreover, pharmacokinetics becomes almost unpredictable due to fluctuations in kidney function depending on patient factors such as volume status, other medication actions, or enzyme build of certain

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.81695

**Function**

**Function**

Shakhsanam Mirishova and

Shakhsanam Mirishova

**Abstract**

chronic pain

**1. Introduction**

individual.

Yasser Mahmoud Hammad Ali Hammad

http://dx.doi.org/10.5772/intechopen.81695

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

and feasibility of alternative pain management techniques.

and Yasser Mahmoud Hammad Ali Hammad

#### **Pain Management in Patients with Impaired Kidney Function Pain Management in Patients with Impaired Kidney Function**

DOI: 10.5772/intechopen.81695

Shakhsanam Mirishova and Yasser Mahmoud Hammad Ali Hammad Shakhsanam Mirishova and Yasser Mahmoud Hammad Ali Hammad

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.81695

#### **Abstract**

Huge numbers of patients referred to pain service have kidney function impairment to some extent. Pain physicians face puzzling cases and may find themselves struggling and divided between the decisions of providing adequate pain reliever, at the same time avoiding further damage to kidneys, and excessive accumulation of medications and their metabolites, also negative interactions with patient's other medications. In this chapter, we will reason about the prevalence of pain in patients with renal impairment, pharmacodynamics and pharmacokinetics of pain medications in this group, optimization of pain control, preferred choice of drugs according to the level of kidney damage, and feasibility of alternative pain management techniques.

**Keywords:** impaired kidney function (IKF), chronic kidney disease (CKD), acute pain, chronic pain

#### **1. Introduction**

Across all subspecialties, pain is the most encountered problem. It is particularly difficult to deal with in patients with organ dysfunction such as acute or chronic kidney failure, due to the fact that most medications depend on kidneys for clearance. Moreover, pharmacokinetics becomes almost unpredictable due to fluctuations in kidney function depending on patient factors such as volume status, other medication actions, or enzyme build of certain individual.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
