Pain ‘exceedingly common’ among patients with cirrhosis before liver transplant
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Key takeaways:
- Nearly 80% of patients with cirrhosis awaiting liver transplant reported clinically significant pain.
- Pain, anxiety and depression were key contributors to reduced health-related quality of life.
VANCOUVER, British Columbia — Pain was reported in nearly 80% of patients with cirrhosis evaluated for liver transplant and, when paired with anxiety and depression, was a significant driver for poor quality of life, noted a presenter here.
“In my clinical work, I have always found it challenging to manage pain in patients with cirrhosis,” Jessica B. Rubin, MD, MPH, assistant professor of medicine in the division of gastroenterology and hepatology at University of California, San Francisco, told Healio. “I realized that there really is very little published guidance on safe and effective pain management in this population and a lot of confusion among providers, largely because there is very little data in this area.”
To investigate the link between pain, anxiety, depression and health-related quality of life in patients with cirrhosis prior to liver transplantation, Rubin and colleagues examined data from 62 individuals in the Functional Assessment in Liver Transplantation (FrAILT) study.
The researchers performed validated assessments to characterize pain (Brief Pain Inventory-Short Form), anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-8) and liver-specific, health-related quality of life (Chronic Liver Disease Questionnaire). They utilized linear regression to assess demographic and clinical factors predictive of severity of pain and impact of pain on daily functions, as well as examine the association between pain, anxiety/depression and health-related quality of life.
According to study results presented at the 2023 ACG Annual Scientific Meeting, 79% of patients exhibited clinically significant pain, 26% were clinically depressed and 24% reported moderate to severe anxiety.
“This study underscores what prior research has shown, but what is often underrecognized in the field: Pain in cirrhosis patients is exceedingly common,” Rubin said. “Even more interesting is our finding that pain, anxiety and depression are strongly associated with poor quality of life in patients with cirrhosis — even more so than disease severity — and it is the mental health comorbidities that really seem to be the biggest drivers of quality of life in this population.”
Rubin and colleagues also reported that clinical factors, such as frailty and alcohol-related cirrhosis, affected pain in daily functions; however, these factors did not correlate with pain severity. Depression and anxiety correlated with pain, yet neither liver disease severity nor liver-related complications were linked to pain severity or its effect on daily function. In multivariable regression, the researchers observed that only depression, rather than pain severity, was significantly associated with lower health-related quality of life.
“Given concerns regarding the susceptibility of cirrhosis patients to analgesic-related adverse effects, we need to think creatively about how to safely and effectively improve quality of life in cirrhosis patients with pain,” Rubin told Healio. “Our findings point to other treatment options we perhaps could consider in this population: antidepressants, psychotherapy and nonpharmacologic therapy targeted at anxiety and depression that may safely and effectively reduce pain and improve quality of life.”
She added: “It is important to ask cirrhosis patients about pain, screen them for mental health comorbidities and refer them for appropriate treatment to ensure that we are maximizing not only their quantity, but also quality, of life.”
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Rubin JB, et al. The complex relationship between pain, mental health and quality of life in cirrhosis patients awaiting liver transplant. Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
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