Authors: Shari S Rogal Daniel Winger Klaus Bielefeldt Eva Szigethy
Publish Date: 2013/03/20
Volume: 58, Issue: 10, Pages: 2976-2985
Abstract
This was a retrospective cohort study of consecutive patients with chronic liver disease visiting a tertiarycare hepatology clinic Pain was determined by selfreport 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 useAmong 1286 patients with chronic liver disease 34 had pain and 25 used opioids The strongest predictor of pain in multivariate modeling was emotional distress OR 366 95 CI 240–564 followed by nonwhite race OR 187 95 CI 124–279 mood symptoms OR 147 95 CI 104–207 sleep disturbance/fatigue OR 170 95 CI 124–232 and advanced liver disease Child class B OR 173 95 CI 115–260 Child class C OR 278 95 CI 149–524 compared to no cirrhosis Emotional distress moodrelated symptoms and advanced liver disease were also significant predictors of prescription opioid use as were age nicotine use and etiology of liver diseaseThis 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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