Dialysis involves some discomfort, but the process itself is not typically described as painful once the needles are in place. The most painful moment for hemodialysis patients is needle insertion, which averages about a 4.8 out of 10 on a pain scale. The blood-filtering process that follows is painless, though side effects like cramping and nausea can develop during or after a session. Peritoneal dialysis, the other main type, involves no needles at all and is generally not painful.
Needle Insertion Is the Most Painful Part
Hemodialysis requires two needles to be placed into a surgically created access point in your arm, called a fistula. These needles connect you to the machine that filters your blood. The insertion is the part most people dread, and the data backs that up. In a study of over 100 hemodialysis patients, the average pain score at the moment of needle insertion was 4.8 out of 10, which falls in the moderate range. About 46% of patients rated the pain as moderate, 25% called it severe, and 28% described it as mild.
That pain is brief. Once the needles are secured and taped in place, most people settle into the session without ongoing needle-related discomfort. But because hemodialysis typically happens three times a week, even moderate pain adds up psychologically. Being stuck with large-bore needles hundreds of times a year is one of the biggest quality-of-life concerns dialysis patients report.
What Happens During the Session
Once the needles are placed, your blood flows through a filter called a dialyzer, which removes waste and excess fluid. You won’t feel the blood moving through the tubing or the filter. The machine does this work quietly while you sit or recline in a chair, typically for three to four hours.
What you may feel during the session is related to fluid removal. Hemodialysis pulls excess water from your body, and if you’ve accumulated a lot of fluid between sessions, this can cause nausea, abdominal cramps, and drops in blood pressure. These side effects range from mildly uncomfortable to genuinely unpleasant, depending on how much fluid needs to come off. If cramping or nausea becomes a problem, the care team can adjust the speed of fluid removal or modify the dialysis solution to reduce symptoms.
Some patients also experience headaches or dizziness during treatment, particularly toward the end of a session. Muscle cramps in the legs are common. None of these are sharp or acute pain in the way needle insertion is, but they contribute to the overall discomfort many people associate with dialysis.
Peritoneal Dialysis Feels Different
Peritoneal dialysis uses the lining of your abdomen as a natural filter instead of an external machine. A permanent catheter is placed in your belly through a minor surgical procedure (which involves its own recovery period), but once healed, the ongoing treatments don’t involve needles at all. A cleaning solution flows into your abdomen through the catheter, sits there while it absorbs waste, and then drains out.
Cleveland Clinic describes peritoneal dialysis as not painful. The main sensation is fullness or bloating while the fluid sits in your abdomen, which some people find uncomfortable but not painful. This type of dialysis can be done at home, often overnight while you sleep, which many patients prefer for both comfort and lifestyle reasons.
Numbing Creams Can Help With Needle Pain
If needle insertion pain is a major concern, numbing creams applied to the skin before your session can make a significant difference. The most widely studied option is a cream containing lidocaine and prilocaine (commonly sold as EMLA). Applied 60 to 90 minutes before needling, it has been shown in multiple randomized controlled trials to meaningfully reduce pain. In one study, patients using the numbing cream reported an average pain score of about 1 out of 10, compared to 3.3 out of 10 with a placebo. None of the patients using the cream experienced severe pain, versus nearly 20% in the placebo group.
Other topical options include a liposomal lidocaine cream, which works comparably, and tetracaine gel, which some research suggests may actually be more effective than EMLA. Not every dialysis center offers these routinely, so it’s worth asking your care team about them if needle pain is bothering you. Some patients also use ice or cold spray before insertion, though studies show numbing creams outperform these alternatives.
The Exhaustion After Treatment
Pain isn’t limited to what happens during the session. Post-dialysis fatigue is one of the most common and disruptive symptoms patients deal with. About 68% of hemodialysis patients need more than two hours to recover after a treatment, and 27% need more than six hours. Patients often describe feeling drained or wiped out, needing to sleep or rest before they can return to normal activities.
This recovery period can include lingering headaches, muscle cramps, and general body aches on top of the fatigue. For someone on a three-times-per-week schedule, losing half a day or more to recovery after each session has a real impact on work, family life, and overall well-being. Recovery time varies widely between individuals, and factors like fluid intake between sessions, nutritional status, and how well the dialysis prescription matches your body’s needs all play a role.
Chronic Pain Is Common in Dialysis Patients
Beyond the procedure itself, many people on dialysis live with ongoing pain related to their underlying kidney disease. Research estimates that between 33% and 82% of hemodialysis patients experience chronic pain, a strikingly wide range that reflects differences in how pain is measured across studies. This chronic pain is separate from the acute discomfort of the treatment and can include joint pain, nerve pain in the hands and feet, bone pain, and muscle aches tied to the metabolic changes that come with kidney failure.
Managing this background pain requires careful medication choices because kidneys normally filter out many pain relievers. Acetaminophen is considered the safest starting point. Anti-inflammatory drugs like ibuprofen can be used in limited situations under close monitoring, but they carry additional risks for people with kidney disease. Doses generally need to start lower and increase slowly compared to what someone with healthy kidneys would take. For nerve-related pain, treatments follow standard guidelines but again require dose adjustments.
A Rare but Serious Complication
A small number of patients develop a condition called steal syndrome after their fistula is created. This happens when the surgical connection diverts too much blood away from the hand, starving the tissues downstream of oxygen. Symptoms include pain, coldness, numbness, or weakness in the hand, particularly during dialysis sessions when blood flow through the fistula increases. Steal syndrome is a recognized complication that may need surgical correction if symptoms are significant. If you notice persistent hand pain, tingling, or color changes after fistula creation, that warrants prompt attention from your care team.