ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2015
Inflammation, psychiatric symptoms, and opioid use are associated with pain and disability in patients with cirrhosis.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 56 citations in OpenAlex.
- Symptom prevalence and quality of life of patients with end-stage liver disease: A systematic review and meta-analysis.Palliative medicine · 2019Pooled it
- A tailored pain self-management intervention for patients with cirrhosis is acceptable and improves pain control.Hepatology communications · 2026Article
- Navigating Chronic Pain in Patients with Cirrhosis: Unique Analgesic Considerations and Non-Pharmacologic Options.Current hepatology reports · 2026Review
- Depression and Gastrointestinal Health Abnormalities: Treatment Approaches from the Perspective of Traditional Chinese Medicine.Neuropsychiatric disease and treatment · 2026Review
- Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis: The Patient and Physician Perspective.Journal of clinical medicine · 2023Review
- Using Intervention Mapping to Develop a Novel Pain Self-Management Intervention for People with Cirrhosis.Digestive diseases and sciences · 2022Article
- AASLD Practice Guidance: Palliative care and symptom-based management in decompensated cirrhosis.Hepatology (Baltimore, Md.) · 2022Article
- Medication Treatment of Active Opioid Use Disorder in Veterans With Cirrhosis.The American journal of gastroenterology · 2021Article
- Review
- Inconsistent Time-Dependent Effects of Tetramethylpyrazine on Primary Neurological Disorders and Psychiatric Comorbidities.Frontiers in pharmacology · 2021Article
- Opioid Use Is More Common in Nonalcoholic Fatty Liver Disease Patients with Cirrhosis, Higher BMI, and Psychiatric Disease.Digestive diseases (Basel, Switzerland) · 2021Observational
- Characteristics of opioid prescribing to outpatients with chronic liver diseases: A call for action.PloS one · 2021Article
- A scoping review to identify and map the multidimensional domains of pain in adults with advanced liver disease.Canadian journal of pain = Revue canadienne de la douleur · 2020Article
- Health-related quality of life and patient-reported outcome measures in NASH-related cirrhosis.JHEP reports : innovation in hepatology · 2020Article
- Opioid prescriptions are associated with hepatic encephalopathy in a national cohort of patients with compensated cirrhosis.Alimentary pharmacology & therapeutics · 2020Article
- Article
- In inpatients with cirrhosis opioid use is common and associated with length of stay and persistent use post-discharge.PloS one · 2020Article
- Characteristics of Opioid Prescriptions to Veterans With Cirrhosis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2019Article
- Integrating Care for Patients With Chronic Liver Disease and Mental Health and Substance Use Disorders.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2018Article
- The assessment and management of pain in cirrhosis.Current hepatology reports · 2018Article
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
BACKGROUND &
aimsCirrhosis is associated with significant pain and disability, the etiologies of which are poorly understood. We investigated whether the pain and disability in patients with cirrhosis are associated with systemic inflammation and psychiatric symptoms.
methodsIn a prospective study, we recruited 193 patients with cirrhosis caused by hepatitis C virus infection, nonalcoholic steatohepatitis, or alcohol from the hepatology clinic at the University of Pittsburgh. Patients were assessed using the McGill Pain Questionnaire, the Hospital Anxiety and Depression Scale, the Pittsburgh Sleep Quality Index, and the Pain Disability Index. Serum samples were collected and markers of inflammation were measured using standardized Luminex assays (Milipore, St. Charles, MO). We evaluated factors associated with pain, pain-related disability, and chronic opioid use by using multivariable regression models.
resultsPain was reported by 79% of patients, pain-related disability was reported by 75%, and depression and/or anxiety was reported by 47%; the average Model for End-Stage Liver Disease score was 12 ± 5. Serum samples from 58% percent of patients had increased levels of C-reactive protein. Opioids were prescribed for 30% of patients with pain. In multivariate analysis, factors significantly associated with pain included younger age (odds ratio [OR]/y, 0.93; 95% confidence interval [CI], 0.90-0.99), serum level of interleukin 6 (OR per pg/L, 1.63; 95% CI, 1.09-2.58), Hospital Anxiety and Depression Scale score (OR/point, 1.14; 95% CI, 1.07-1.24), and etiology (hepatitis C virus infection vs alcohol: OR, 3.70; 95% CI, 1.27-11.11). Disability scores were related significantly to psychiatric symptoms (incidence rate ratio [IRR]/point, 1.04; 95% CI, 1.02-1.05), prescription opioid use (IRR, 1.49; 95% CI, 1.14-1.94), Model for End-Stage Liver Disease score (IRR/point, 1.02; 95% CI, 1.0001-1.05), level of C-reactive protein (IRR per mg/dL, 1.13; 95% CI, 1.02-1.24), and pain severity (IRR/point, 1.19; 95% CI, 1.08-1.32).
conclusionsPain and disability are common among patients with cirrhosis, and are associated with inflammation, psychiatric symptoms, and opioid use, which potentially are modifiable. Although opioids are used commonly to treat pain, psychiatric symptoms and inflammation also might be treatment targets in this population.
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