The assessment and management of pain in cirrhosis

Abstract

Purpose of review: The treatment of pain in patients with cirrhosis is complicated by unpredictable hepatic drug metabolism and a higher risk of adverse drug reactions. We aimed to conduct a scoping review regarding pain management in cirrhosis.

Recent findings: Despite the high prevalence of pain in patients with cirrhosis, there is little literature to guide the management of pain in this population. Complex pain syndromes and disease-specific pain etiologies exist are common in patients with cirrhosis. There are numerous contraindications and limitations when considering pharmacotherapy for analgesia in cirrhosis, specifically with non-steroidal anti-inflammatory drugs (NSAIDS) and opioid medications. Non-pharmacologic therapies for pain have not been specifically assessed in this population.

Summary: As with other populations, a multi-dimensional treatment approach to pain with a focus on physical, behavioral, procedural and pharmacologic treatment is recommended when caring for patients with cirrhosis and pain. However, more research is needed to evaluate opioid-sparing and non-pharmacologic analgesia in this population.

Keywords: analgesia; chronic liver disease; cirrhosis; pain.

Conflict of interest statement

Conflict of Interest Shari Rogal reports grants from Gilead Sciences, outside of the submitted work. Matthew Klinge, Tami Coppler, Jane M. Liebschutz, Mohannad Dugum, Ajay Wassan, and Andrea DiMartini each declare no conflicts of interest. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors

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Pain Management in Cirrhosis: Multi-dimensional Treatment Approach