M D Coates1, N Seth2, K Clarke3, H Abdul-Baki4, N Mahoney5, V Walter6, M D Regueiro7, C Ramos-Rivers5, I E Koutroubakis5, K Bielefeldt8, D G Binion5. 1. Division of Gastroenterology and Hepatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, 17033, USA. mcoates@pennstatehealth.psu.edu. 2. Division of Gastroenterology and Hepatology, Department of Medicine, University of Texas Southwestern, Houston, TX, USA. 3. Division of Gastroenterology and Hepatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, 17033, USA. 4. Division of Gastroenterology and Hepatology, Department of Medicine, Allegheny Health System, Pittsburgh, PA, USA. 5. Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 6. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA. 7. Division of Gastroenterology and Hepatology, Department of Medicine, Cleveland Clinic, Cleveland, OH, USA. 8. Division of Gastroenterology and Hepatology, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
Abstract
BACKGROUND: Abdominal pain and opioid analgesic use are common in Crohn's disease (CD). AIMS: We sought to identify factors associated with abdominal pain in CD and evaluate the impact of opioid analgesics on pain and quality-of-life scores in this setting. METHODS: We performed a longitudinal cohort study using a prospective, consented IBD natural history registry from a single academic center between 2009 and 2013. Consecutive CD patients were followed for at least 1 year after an index visit. Data were abstracted regarding pain experience (from validated surveys), inflammatory activity (using endoscopic/histologic findings), laboratory studies, coexistent psychiatric disorders, medical therapy, opioid analgesic, and tobacco use. RESULTS: Of 542 CD patients (56.6% women), 232 (42.8%) described abdominal pain. Individuals with pain were more likely to undergo surgery and were more frequently prescribed analgesics and/or antidepressants/anxiolytics. Elevated ESR (OR 1.79; 95%CI 1.11-2.87), coexistent anxiety/depression (OR 1.87; 95%CI 1.13-3.09), smoking (OR 2.08; 95%CI 1.27-3.40), and opioid use (OR 2.46; 95%CI 1.33-4.57) were independently associated with abdominal pain. Eighty patients (14.8%) were prescribed opioids, while 31 began taking them at or after the index visit. Patients started on opioids demonstrated no improvement in abdominal pain or quality-of-life scores on follow-up compared to patients not taking opioids. CONCLUSIONS: Abdominal pain is common in CD and is associated with significant opioid analgesic utilization and increased incidence of anxiety/depression, smoking, and elevated inflammatory markers. Importantly, opioid use in CD was not associated with improvement in pain or quality-of-life scores. These findings reinforce the limitations of currently available analgesics in IBD and support exploration of alternative therapies.
BACKGROUND:Abdominal pain and opioid analgesic use are common in Crohn's disease (CD). AIMS: We sought to identify factors associated with abdominal pain in CD and evaluate the impact of opioid analgesics on pain and quality-of-life scores in this setting. METHODS: We performed a longitudinal cohort study using a prospective, consented IBD natural history registry from a single academic center between 2009 and 2013. Consecutive CDpatients were followed for at least 1 year after an index visit. Data were abstracted regarding pain experience (from validated surveys), inflammatory activity (using endoscopic/histologic findings), laboratory studies, coexistent psychiatric disorders, medical therapy, opioid analgesic, and tobacco use. RESULTS: Of 542 CDpatients (56.6% women), 232 (42.8%) described abdominal pain. Individuals with pain were more likely to undergo surgery and were more frequently prescribed analgesics and/or antidepressants/anxiolytics. Elevated ESR (OR 1.79; 95%CI 1.11-2.87), coexistent anxiety/depression (OR 1.87; 95%CI 1.13-3.09), smoking (OR 2.08; 95%CI 1.27-3.40), and opioid use (OR 2.46; 95%CI 1.33-4.57) were independently associated with abdominal pain. Eighty patients (14.8%) were prescribed opioids, while 31 began taking them at or after the index visit. Patients started on opioids demonstrated no improvement in abdominal pain or quality-of-life scores on follow-up compared to patients not taking opioids. CONCLUSIONS:Abdominal pain is common in CD and is associated with significant opioid analgesic utilization and increased incidence of anxiety/depression, smoking, and elevated inflammatory markers. Importantly, opioid use in CD was not associated with improvement in pain or quality-of-life scores. These findings reinforce the limitations of currently available analgesics in IBD and support exploration of alternative therapies.
Authors: Stanley M Cheatham; Karan H Muchhala; Eda Koseli; Joanna C Jacob; Essie Komla; S Stevens Negus; Hamid I Akbarali Journal: Front Pain Res (Lausanne) Date: 2021-12-13
Authors: Amir L Bastawrous; Kara K Brockhaus; Melissa I Chang; Gediwon Milky; I-Fan Shih; Yanli Li; Robert K Cleary Journal: Surg Endosc Date: 2021-02-10 Impact factor: 4.584