Zhang Grace Y, Cortella Aly, Lai Jennifer C, Rubin Jessica B
Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco California, USA.
Department of Epidemiology and Biostatistics, University of California San Francisco California, USA.
Hepatol Commun. 2024 Dec 11;9(1). doi: 10.1097/HC9.0000000000000605. eCollection 2025 Jan 1.
Pain is common in patients with chronic liver disease. Our limited understanding of patterns and severity of pain in this population hinders the development of effective cirrhosis-specific pain management strategies.
Using cross-sectional data from the 2016-2021 National Health Interview Survey, we examined rates, severity, and functional limitations due to pain in respondents with liver disease (viral hepatitis, cirrhosis, and liver cancer), compared to the general population and those with other chronic conditions associated with pain (ie, arthritis, diabetes, and chronic kidney disease). Categorical and continuous variables were compared using χ2 and t test. Multivariable logistic regression was used to determine the predictors associated with pain and opioid use.
Our liver disease cohort comprised 5267 participants (63% viral hepatitis, 49% cirrhosis, and 2% liver cancer). Participants with liver disease were more likely to report pain than those without liver disease (42% vs. 22%); they were also more likely to report severe pain (42% vs. 30%) and functional limitations by pain (28% vs. 13%) (p < 0.001 for all). On multivariable logistic regression, liver disease is an independent predictor of pain (OR: 2.31, 95% CI: 2.05-2.59, p < 0.001), even after adjustment for demographic factors. Liver disease respondents had similar rates of pain as those with diabetes (p = 0.8) and were more functionally limited by pain than those with arthritis (p < 0.001). Adjusted for demographic and pain-related factors, liver disease was also an independent predictor of chronic opioid use (OR: 1.47, 95% CI: 1.12-1.92, p = 0.0054).
Liver disease independently increases the likelihood of experiencing widespread and debilitating pain. Clinicians should consider liver disease a painful condition, ensuring that they are frequently assessing and appropriately treating pain in all liver disease patients.
疼痛在慢性肝病患者中很常见。我们对这一人群疼痛模式和严重程度的有限了解阻碍了有效的肝硬化特异性疼痛管理策略的发展。
利用2016 - 2021年美国国家健康访谈调查的横断面数据，我们研究了肝病（病毒性肝炎、肝硬化和肝癌）患者因疼痛导致的发生率、严重程度和功能受限情况，并与普通人群以及患有其他与疼痛相关的慢性病（如关节炎、糖尿病和慢性肾病）的人群进行比较。使用卡方检验和t检验比较分类变量和连续变量。多变量逻辑回归用于确定与疼痛和阿片类药物使用相关的预测因素。
我们的肝病队列包括5267名参与者（63%为病毒性肝炎，49%为肝硬化，2%为肝癌）。肝病患者比无肝病患者更有可能报告疼痛（42%对22%）；他们也更有可能报告严重疼痛（42%对30%）以及因疼痛导致功能受限（28%对13%）（所有p值均<0.001）。在多变量逻辑回归分析中，即使在调整人口统计学因素后，肝病仍是疼痛的独立预测因素（比值比：2.31，95%置信区间：2.05 - 2.59，p<0.001）。肝病受访者的疼痛发生率与糖尿病患者相似（p = 0.8），且因疼痛导致的功能受限比关节炎患者更严重（p<0.001）。在调整人口统计学和疼痛相关因素后，肝病也是慢性阿片类药物使用的独立预测因素（比值比：1.47，95%置信区间：1.12 - 1.92，p = 0.0054）。
肝病独立增加了经历广泛且使人衰弱的疼痛的可能性。临床医生应将肝病视为一种疼痛性疾病，确保他们经常评估并适当治疗所有肝病患者的疼痛。
