Pain management in patients with chronic kidney disease (CKD) often goes something like this: NSAIDs are evil, acetaminophen hardly works, opioids are dangerous, and all the rest (tramadol, gabapentinoids, antidepressants) are messy. But, we tackle the complexities of pain management in patients with chronic kidney disease in this special @NephMadness 2019 episode that, on a scale of 1-10, will leave you feeling very relieved in addressing pain. Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Earn CME and read about each region in NephMadness 2019 at AJKD blog. Credits Written and produced by: Justin Berk MD, Samantha Gelfand MD NephMadness Pun Contest produced by: Hannah R Abrams MS3 Cover art by: Kate Grant MBChB, Dip GUMed Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Edited by: Matthew Watto MD, Emi Okamoto MD Guests:  Samantha Gelfand MD, Matthew Sparks MD, David Juurlink MD  Time Stamps 00:00 Kidney Pun 01:19 Disclaimer, intro and guest bios 06:30 Guest one-liners 10:42 Books recommendations, staff picks and a patient complaint 15:25 Clinical Case and Pain Management Disclaimer 16:33 Modalities in pain medicine 18:20 Opioids for pain and their metabolites 20:44 Dave Juurlink reframes the question, “what is our real goal with pain management?” 24:42 Matt Sparks reiterates the dangers of morphine and codeine in patients with advanced CKD 27:44 Communicating meds that are contraindicated or relatively contraindicated in CKD 30:40 Buprenorphine 32:40 What about the WHO Pain Ladder for CKD?; 33:32 Should we use more cannabinoids? Ketamine? 37:07 Dave Juurlink rants on Tramadol 44:20 How to pick winners in NephMadness 46:06 NSAIDS and CKD 57:07 Gabapentinoids (gabapentin and pregabalin) for neuropathic pain and driving?! 65:57 Estimating eGFR in CKD and AKI. Which equation is best? 70:38 How would each of our experts treat this patient with CKD and knee pain 75:20 NephMadness 2019 picks for the pain region 82:55 Outro