Pain Management in Calciphylaxis

Pain management in calciphylaxis is challenging due to the complex etiology of pain. Effective pain control requires multimodal treatment to limit further ischemic damage by inhibiting vascular calcification, minimizing thrombosis, and promoting wound healing. Efficacy of available pharmacological and nonpharmacological interventions is still unclear, with individual responses varying between patients. Other modalities for calciphylaxis pain include aggressive titration of opioids and the addition of neuropathic pain agents. As patients with calciphylaxis often have impaired renal function, all pharmacotherapeutic selection should take into consideration the need for renal dose adjustments and risk of renal toxicity. Last, discussions on goals of care are important given the rapid progression and high symptom burden of calciphylaxis. Important topics to discuss include dialysis, kidney transplantation, and end-of-life care.