title: Pain and opioid use in chronic liver disease.
abstract: BACKGROUND
  Pain is common in patients with liver disease, difficult to treat, and poorly understood.
  
  
  OBJECTIVE
  The aim of this study was to determine factors associated with pain and prescription opioid use in a large cohort of patients with confirmed chronic liver disease.
  
  
  METHODS
  This was a retrospective cohort study of consecutive patients with chronic liver disease visiting a tertiary-care hepatology clinic. Pain was determined by self-report 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 use.
  
  
  RESULTS
  Among 1,286 patients with chronic liver disease, 34 % had pain and 25 % used opioids. The strongest predictor of pain in multivariate modeling was emotional distress (OR 3.66, 95 % CI 2.40-5.64), followed by non-white race (OR 1.87, 95 % CI 1.24-2.79), mood symptoms (OR 1.47, 95 % CI 1.04-2.07), sleep disturbance/fatigue (OR 1.70, 95 % CI 1.24-2.32), and advanced liver disease (Child class B: OR 1.73, 95 % CI 1.15-2.60; Child class C: OR 2.78, 95 % CI 1.49-5.24) compared to no cirrhosis. Emotional distress, mood-related symptoms, and advanced liver disease were also significant predictors of prescription opioid use, as were age, nicotine use, and etiology of liver disease.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, 200 Lothrop Street, C Wing, M Level, PUH, Pittsburgh, PA, 15213, USA, rogalss@upmc.edu.
authors.forename: Shari S
authors.initials: SS
authors.lastname: Rogal
authors.forename: Daniel
authors.initials: D
authors.lastname: Winger
authors.forename: Klaus
authors.initials: K
authors.lastname: Bielefeldt
authors.forename: Eva
authors.initials: E
authors.lastname: Szigethy
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D055656:Prescriptions / Q000706:statistics & numerical data*; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000701:Analgesics, Opioid