There are several reasons to experience pain with hemodialysis. The most common source of the pain is experienced during cannulation (inserting large-bore needles into the skin and the vein) prior to hemodialysis. This is expected since the needles for hemodialysis have a larger diameter. However, over the course of 2 to 3 months, the skin will build scar tissues over the cannulation sites and the patient feels pressure instead of pain upon cannulation.

Other sources of pain during hemodialysis can be from poor perfusion to the distal limb where the dialysis access has been placed. The patients who experience pain, numbness or feeling of pins and needles with unbearable throbbing in their hands and fingers either immediately after the creation of arteriovenous shunts graft or during hemodialysis may be experiencing something called “The Steal Syndrome”. In this condition, the blood is directed more into the dialysis shunt than the distal extremity. The involved hand then has very poor baseline perfusion which leads to demand ischemia. If this condition persists or worsened, the patient may develop permanent nerve damage and tissue loss with risk for major limb amputation. Patients should immediately seek help from their vascular surgeon if they are experiencing pain in their hand with AVF/AVG on the same extremity. This condition can be surgically corrected and saves the patient from any future limb loss.