Gorospe Franklin F F, Wong David, Lee Elizabeth, Puts Martine, Brennenstuhl Sarah, Dale Craig M
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Perioperative Services, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Gastro Hep Adv. 2025 Jun 24;4(10):100734. doi: 10.1016/j.gastha.2025.100734. eCollection 2025.
Patients with liver disease report unrelieved pain. Exploring the multidimensional nature of pain provides insights into its burden and management needs in cirrhosis. This study explored biopsychosocial factors of pain and the relationship between pain intensity and liver disease severity.
A cross-sectional survey design was conducted at a Canadian ambulatory hepatology clinic in 2021. Eligible participants were ≥18 years with a documented the Model for End-stage Liver Disease with Sodium (MELD-Na) score. We report pain characteristics, self-care management, and pain interference using the Brief Pain Inventory. Multiple linear regression analyses examined the relationship between MELD-Na and pain intensity.
Of 118 participants (98% response rate), 61.9% were male, 59 ± 11.8 years of age. Leading diagnoses were alcohol related (34.7%) and viral hepatitis (21.2%), and 89.8% had decompensated cirrhosis. The composite pain intensity mean score was 4 ± 2.4. Common pain sites included: abdomen (83.1%), lower legs (59.3%), and lower back (56.8%). Pain interference scores ranged from general activity 5.8 ± 3.1, walking ability 5.7 ± 3.3, and sleep 5.6 ± 3.6. Use of self-management strategies for pain was reported by 37.3%, primarily oral analgesics; no social or psychological strategies were reported. Multiple regression analysis indicated that pain intensity was associated with liver disease severity. MELD-Na 23-31 (β = 0.43), 21-22 (β = 0.28), and 17-20 (β = 0.19). Physical factors associated with pain intensity included ascites (β = 0.16) and edema (β = 0.28).
We observed moderate pain and pain-related activity interference in adults with cirrhosis. Ascites, edema, and liver disease severity were associated with pain intensity. More research is needed to explore biopsychosocial pain management interventions for this population.
肝病患者诉说疼痛未得到缓解。探究疼痛的多维度性质有助于深入了解其在肝硬化中的负担及管理需求。本研究探讨了疼痛的生物心理社会因素以及疼痛强度与肝病严重程度之间的关系。
2021年在加拿大一家门诊肝病诊所进行了一项横断面调查设计。符合条件的参与者年龄≥18岁，有记录的终末期肝病钠模型（MELD-Na）评分。我们使用简明疼痛量表报告疼痛特征、自我护理管理和疼痛干扰情况。多元线性回归分析检验了MELD-Na与疼痛强度之间的关系。
在118名参与者中（应答率98%），61.9%为男性，年龄59±11.8岁。主要诊断为酒精相关性（34.7%）和病毒性肝炎（21.2%），89.8%患有失代偿期肝硬化。疼痛强度综合平均评分为4±2.4。常见疼痛部位包括：腹部（83.1%）、小腿（59.3%）和下背部（56.8%）。疼痛干扰评分范围为：一般活动5.8±3.1、行走能力5.7±3.3和睡眠5.6±3.6。37.3%的人报告使用了疼痛自我管理策略，主要是口服镇痛药；未报告社交或心理策略。多元回归分析表明，疼痛强度与肝病严重程度相关。MELD-Na 23 - 31（β = 0.43）、21 - 22（β = 0.28）和17 - 20（β = 0.19）。与疼痛强度相关的身体因素包括腹水（β = 0.16）和水肿（β = 0.28）。
我们观察到肝硬化成人存在中度疼痛及与疼痛相关的活动干扰。腹水、水肿和肝病严重程度与疼痛强度相关。需要更多研究来探索针对该人群的生物心理社会疼痛管理干预措施。
