Opioid Analgesics Do Not Improve Abdominal Pain or Quality of Life in Crohn’s Disease

M. D. Coates, N. Seth, K. Clarke, H. Abdul-Baki, N. Mahoney, V. Walter, M. D. Regueiro, C. Ramos-Rivers, I. E. Koutroubakis, K. Bielefeldt, D. G. Binion

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4 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2379-2387
Number of pages9
JournalDigestive Diseases and Sciences
Volume65
Issue number8
DOIs
StatePublished - Aug 1 2020

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

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    Coates, M. D., Seth, N., Clarke, K., Abdul-Baki, H., Mahoney, N., Walter, V., Regueiro, M. D., Ramos-Rivers, C., Koutroubakis, I. E., Bielefeldt, K., & Binion, D. G. (2020). Opioid Analgesics Do Not Improve Abdominal Pain or Quality of Life in Crohn’s Disease. Digestive Diseases and Sciences, 65(8), 2379-2387. https://doi.org/10.1007/s10620-019-05968-x