Prevalence, severity and multidimensional factors associated with pain among hemodialysis patients: A cross-sectional study in a resource-limited healthcare system

Objectives This study aimed to determine the prevalence, severity and multidimensional factors associated with pain among hemodialysis (HD) patients in a resource-limited healthcare system. Methods A multicenter cross-sectional study was conducted across eight hospitals in the West Bank of Palestine, enrolling 361 adult patients on maintenance HD. Pain intensity was measured using the Visual Analog Scale (VAS), pain interference with the Brief Pain Inventory (BPI) and health-related quality of life with the EuroQol 5-Dimension 5-Level (EQ-5D-5L). Results Pain was reported by 281 patients, corresponding to a prevalence of 77.8%, with more than half (53.8%) experiencing moderate to severe intensity. Gender (OR = 2.29, 95% CI: 1.17-4.50), comorbid chronic diseases (OR = 3.62, 95% CI: 1.59-8.23), and HD vintage (OR = 1.12, 95% CI: 1.04-1.20) were independently associated with presence of pain. Pain severity was higher among females (B = 0.86, p = 0.006) and those with longer HD vintage (B = 0.05, p = 0.047), while smoking was linked to lower scores (B = -0.59, p = 0.006). Pain interference was higher in females (B = 1.23, p < 0.001) and patients with chronic diseases (B = 1.46, p = 0.001). Lower EQ-5D utility values were associated with age (β = -0.19, p = 0.003) and regular exercise (B = -0.14, p = 0.011). Self-assessed health scores declined with age (B = -0.23, p < 0.001) and chronic diseases (B = -4.69, p = 0.041). Pain control effectiveness was negatively associated with employment status (B = -2.53, p = 0.001). Conclusion Pain is highly prevalent and undertreated among HD patients. The findings underscore the need for multidisciplinary, culturally sensitive strategies integrating pharmacologic, non-pharmacologic, psychosocial and spiritual care to better manage pain and enhance patient quality of life.