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. 2013 Oct;58(10):2976-85.
doi: 10.1007/s10620-013-2638-5. Epub 2013 Mar 20.

Pain and opioid use in chronic liver disease

Shari S Rogal  1 , Daniel Winger, Klaus Bielefeldt, Eva Szigethy
Affiliations

Pain and opioid use in chronic liver disease

Shari S Rogal et al. Dig Dis Sci. 2013 Oct.

Abstract

Background: Pain is common in patients with liver disease, difficult to treat, and poorly understood.

Aims: The aim of this study was to determine factors associated with pain and prescription opioid use in a large cohort of patients with confirmed chronic liver disease.

Methods: This was a retrospective cohort study of consecutive patients with chronic liver disease visiting a tertiary-care hepatology clinic. Pain was determined by self-report and rated numerically from 0 to 10. Symptoms of mood and sleep disorders and emotional distress were based on a symptom checklist. Etiology and stage of liver disease and use of prescribed opioids were abstracted from the electronic medical record. Logistic regression was used to establish factors associated with pain and prescription opioid use.

Results: Among 1,286 patients with chronic liver disease, 34 % had pain and 25 % used opioids. The strongest predictor of pain in multivariate modeling was emotional distress (OR 3.66, 95 % CI 2.40-5.64), followed by non-white race (OR 1.87, 95 % CI 1.24-2.79), mood symptoms (OR 1.47, 95 % CI 1.04-2.07), sleep disturbance/fatigue (OR 1.70, 95 % CI 1.24-2.32), and advanced liver disease (Child class B: OR 1.73, 95 % CI 1.15-2.60; Child class C: OR 2.78, 95 % CI 1.49-5.24) compared to no cirrhosis. Emotional distress, mood-related symptoms, and advanced liver disease were also significant predictors of prescription opioid use, as were age, nicotine use, and etiology of liver disease.

Conclusions: This large cohort study demonstrates the high prevalence of pain and opioid use in chronic liver disease. While disease variables contribute to pain, psychological symptoms were most strongly associated with pain and opioid use, providing rationale and target for therapeutic interventions.

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Figures

Figure 1
Figure 1
Relationship between the number of pain-related symptoms on the review of systems form and other variables
Figure 2
Figure 2
Percentage of patients with pain and opioid use by baseline characteristics
See this image and copyright information in PMC

Comment in

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