The following is the summary of “Cirrhosis Inpatients Receive More Opioids and Fewer Nonopioid Analgesics Than Patients Without Cirrhosis” published in the January 2023 issue of Clinical gastroenterology by Rubin, et al.
The majority of people with cirrhosis have some level of pain, and those who are hospitalized due to a severe illness are especially vulnerable to pain. Due to lack of standards for analgesic use and worries about side effects, pain management in this population is difficult. Researchers aimed to describe the prevalence and characteristics of cirrhosis-related pain among hospitalized patients and to identify differences in prescribing practices between hospitals serving patients with and without cirrhosis. Their methodology involved looking at clinical and billing data from hospitalizations at more than 500 US academic medical facilities that are part of the Vizient Clinical Database.
Hospitalized individuals with cirrhosis in 2017 and 2018 were identified, along with a matched sample of noncirrhotic patients. Prescription data from hospitals were used to categorize analgesics into 4 categories: acetaminophen (APAP), NSAIDs, opioids, and adjuvants (e.g., gabapentinoids, antidepressants). Analgesic usage was linked to cirrhosis by conditional logistic regression. Among 116,363 hospitalized individuals with cirrhosis, 83% got at least 1 dosage of an analgesic, and 58% had regular inpatient painkiller use, rates that were clinically equivalent to noncirrhosis controls. Hospitalized patients with cirrhosis were less likely to receive APAP (26% vs. 42%, P<0.01) or NSAIDs (3% vs. 7%, P<0.01), but were more likely to receive opioids (59% vs. 54%, P<0.01), especially decompensated patients (60%).
Prescription patterns for analgesics varied significantly between hospitals, with the greatest variation seen in cirrhosis patients. Patients with and without cirrhosis had similar rates of analgesic usage among inpatients, leading us to the conclusion that their use was widespread. Opioid analgesics were prescribed more frequently to cirrhosis patients than APAP and NSAIDs, especially to those who were already in a state of decompensation. Medical professionals may overuse opioids in this high-risk population due to a lack of evidence-based recommendations for the management of pain in cirrhosis patients.