“Is dialysis painful, doctor?” — this is the one question that most patients and their families are apprehensive about before initiating on dialysis. The usual assumption is that dialysis is a very painful procedure. In this post, I will try to answer this question of pain and dialysis as comprehensively as possible.
But before that I will try to provide the gist of my answer as follows:
Dialysis is not a process that is painful throughout the four-hour session. There can be some pain for a few seconds at the beginning of a dialysis session when needles are inserted into the AV fistula. At the end of the session also there can be some pain when the needles are removed. But otherwise, during the rest of the session, no pain is experienced. In fact, many patients make dialysis a positive experience by listening to music/watching movies/meditating or even working during the process.
In the next paragraph, I have listed out the situations in which a dialysis patient can experience pain :
- Dialysis catheter(temporary or tunneled catheter) insertion into the neck if AV fistula has not been created at the time of dialysis initiation
- When AV fistula/AV graft is created in the hand
- Dialysis catheter removal once AV fistula/graft is ready for use
- During dialysis at the beginning and end of dialysis when the needles are inserted/removed
The most important point to note is this :
In none of the above situations is the pain unbearable/unmanageable. We have the means to manage the pain in all the above situations.
For example, during temporary dialysis catheter removal, the pain is so minimal/non-existent that nothing is needed to reduce it. During tunneled dialysis catheter(“Permcath”) removal and temporary dialysis catheter insertion, some local anesthesia is all that is needed to prevent pain.
For tunneled dialysis catheter(“Permcath”) insertion local anesthesia is used along with some mild anesthesia (“sedation”) if needed.
Even during needle insertion/removal during dialysis most patients will not need any anesthesia. Very rarely, in a few patients, I have used local anesthesia when pain was a problem.
Some patients experience muscle cramps during dialysis which can be painful. But this doesn’t occur in all sessions and generally resolves in a few minutes.
Another question that is frequently asked is :
Is AV fistula surgery painful?
An incision(cut) is made in the skin and then stitched at the end of AV fistula surgery. Local anesthesia is given during the surgery to make the procedure almost painless. After the surgery, there can be some pain because of the stitches. This pain generally decreases in a day or two and can be easily managed by oral medications like paracetamol(Crocin, Dolo).
Most of the above situations are with hemodialysis(“blood dialysis”). There is another type of dialysis called “peritoneal dialysis(PD)” which is performed through a tube placed in the abdomen.
Is peritoneal dialysis painful?
Fortunately, there is very little/no pain involved with peritoneal dialysis once it is begun. The PD catheter (tube) is placed in the abdomen through a surgery/procedure. At this time there can be some pain because of the surgery. PD is generally started 10-14 days after the catheter insertion. Once started peritoneal dialysis is essentially painless.
A specialized fluid called “dialysate” is infused into the abdomen and removed after a few hours. This ‘exchange’ is repeated 3-4 times a day. Normally, no pain is experienced during the exchanges. Pain during PD is generally a sign of some complication like infection.
In-fact PD is a good alternative for the few patients with a morbid fear/phobia of being pricked by needles.
In all the above situations I have looked at “pain” in the sense of physical pain.
Of course, there is also “psychological pain” that is involved in the treatment of any disease. A better word to describe this psychological pain is “suffering.” This is the pain that is not physical but is experienced more in the mind. For example, the pain is felt when one is diagnosed with kidney failure and one is advised lifelong dialysis or kidney transplantation. The future may appear bleak and uncertain.
The only advice that I can give as a nephrologist is that there is no need to be overly pessimistic about living life with kidney failure. I personally know many patients who have lived very productive and happy lives in spite of being on dialysis for years and even decades. Some adjustment is needed. For example, colas, pizza, burger and chat items have to be given up. But otherwise, the important things in life like work, exercise, good quality sleep, even marriage and having children can be managed if kidney failure is treated properly.
And now coming to the last aspect of what I want to cover about pain and dialysis. This applies mainly to elderly patients who have been on regular dialysis for some period of time– may be a few years. Most of the time such patients have multiple complications like diabetes, heart problems, paralysis, blocked blood vessels in the limbs, repeated infections, repeated hospital admissions, etc. Many of these patients come to a stage where dialysis may no longer add to the quality of life because of these other complications.
The family and patient may decide that they no longer wish to continue dialysis and opt for just supportive care at home/nursing home. The question that arises is :
Is stopping dialysis painful?
There may not be pain in the physical sense but some suffering occurs because of the build-up of wastes/fluid in the body. These include tiredness, swelling, breathlessness, lack of appetite, vomiting, unconsciousness, heart rhythm disturbances to name a few. Some of these symptoms can be due to multiple factors present in the patient and not just due to stopping dialysis.
For example, breathlessness can be due to underlying heart problems and fluid accumulation in the lungs due to stopping dialysis. The decision to stop dialysis is never taken in haste but after careful consideration of all the factors in a given patient. The patient herself, her family and the nephrologist need to discuss in detail and take the appropriate decision.
There you have it. I have tried to answer this question about dialysis being painful as comprehensively as I could. Hope you find it useful.