A qualitative study examining barriers to buprenorphine for pain management in patients with end stage kidney disease undergoing hemodialysis.

Chronic pain is common and burdensome among people with end stage kidney disease (ESKD). Pain management options are limited and prescription opioids are often used in this population, but carry unwanted risks (e.g., side effects, misuse, overdose). Buprenorphine is increasingly viewed as a safer alternative to full agonist opioids. However, buprenorphine uptake may be inhibited by access barriers and addiction stigma, given its association with opioid use disorder. These concepts have not yet been explored in the context of ESKD and chronic pain, limiting understanding of buprenorphine acceptability in patients with ESKD. Therefore, the current study sought to understand potential barriers to buprenorphine use among people with ESKD and chronic pain receiving in-center hemodialysis treatments. Using a descriptive qualitative approach, qualitative interviews were conducted with 28 patients with ESKD-related pain between April 2022 and January 2024. Thematic analysis was used to analyze interview transcripts. Themes identified included: (1) ESKD is uniquely painful, and accessing pain management is challenging for ESKD patients; (2) ESKD patients experience stigma and discrimination when seeking pain management, which is influenced by the national overdose crisis and resulting deprescribing efforts; and (3) ESKD patients were interested in buprenorphine as an alternative pain management strategy to prescription opioids - in contrast to prior work - participants were comforted by its use in opioid use disorder treatment. These findings highlight a need to identify appropriate providers and systems of care to deliver pain management, and provide non-stigmatizing information to patients regarding buprenorphine as a safer medication alternative. PERSPECTIVE: Co-occurring chronic pain and ESKD are burdensome conditions. Qualitative interviews highlighted difficulties finding a pain provider and experiencing stigma when seeking pain care. Patients were interested in buprenorphine as an alternative to prescription opioids, and were comforted by buprenorphine's perceived safety in opioid use disorder treatment.