Opioid-use associated with pain-related disability among cirrhotic patients

CHICAGO — Patients with cirrhosis who were taking prescription opioids were more likely to experience pain-related disability, according to data presented at Digestive Disease Week 2014.

Researchers conducted a study of 193 cirrhotic patients (mean age, 58 years; 40% women) and used the Pain Disability Index to measure pain-related disability, the McGill Pain Questionnaire to assess pain levels and Luminex assays to measure C-reactive protein and inflammatory cytokines. Hepatitis C virus infection was the cause of liver disease in 40% of the cohort.

Pain-related disability was reported by 75% of patients. The median score of an individual pain severity level (0-10 scale) was 3.0, with pain predominantly occurring in the back, abdomen and joints.

The average Model for End-Stage Liver Disease (MELD) score was 12 ± 5. Univariate analyses revealed that patients with the most pain-related disability were younger, and women experienced it more than men. Among those with most pain-related disability, 47% were using opioids, and those patients had a higher median disability score (6.5; 0-10 scale), compared with nonopioid users (1.7).

Multiple factors that attributed to greater levels of disability were MELD score (IRR=1.03; 95% CI, 1.003-1.05, for each point), pain severity (IRR=1.01; 95% CI, 1.004-1.02), prescription opioid use (IRR=1.58; 95% CI, 1.23-2.05), and hospital anxiety and depression scale score (IRR=1.05; 95% CI, 1.03-1.06).

“Significantly, disability and pain were found in over 75% of our patients with cirrhosis, despite them having low MELD scores,” researcher Shari Rogal, MD, MPH, of the division of gastroenterology, hepatology and nutrition, University of Pittsburgh, said during her presentation. “Opioid use was significantly associated with pain disability. We recommend possibly considering alternative pain regimens in patients with cirrhosis.”

For more information:

Rogal SS. #380. Presented at: Digestive Disease Week 2014; May 3-6; Chicago.

Disclosure: Szigethy reports numerous financial relationships.