Abstract
INTRODUCTION: Pain is a common symptom in chronic pancreatitis (CP) and has a significant impact on quality of life. Although a variety of pain management strategies exist, opioids are the most frequently used analgesic given their high oral bioavailability and activity at multiple neuropathic and visceral pain receptors. Limited data exists on the trends of opioid dependence in CP. Our aim is to characterize trends in opioid use in CP over the last 15 years. METHODS: We performed a retrospective analysis in the IBM Explorys database (1999–2018), a pooled, de-identified clinical database of over 63 million unique patients from 26 health care networks and 300 hospitals across the United States. At the time of analysis there were 63,656,680 patients. Patient populations were identified using SNOMED and ICD codes. Cochrane-Armitage testing analyzed trends in chronic opioid use among CP patients between 2004–2018. Subgroup analysis for gender, age, race, and insurance status were assessed. RESULTS: 83,650 adult patients (>18 years old) had CP. 7,220 patients with CP were opioid dependent. The odds of being opioid dependent if diagnosed with chronic pancreatitis was 21.90 (P < 0.0001). Over the 15-year period, opioid dependence in chronic pancreatitis patients has significantly increased (2.25% to 4.35%; P < 0.0001). Most significant increase is noted among Medicaid (P = 0.0004) and Caucasian (P = 0.0001) patients. CONCLUSION: We present the first study to assess trends in opioid dependence among patients with CP over the last 15 years. Pain management is a critical component of treating CP. Multiple patient-dependent factors influence pain scores and opioid use in CP patients, including a history of alcohol use and psychological comorbidities. Side effects and opioid hyperalgesia significantly hinders their efficacy for long-term pain control.3 Pain exacerbation is the most common reason for hospitalization in CP, resulting in significant cost to the health care system.9 Opioid use and hypoalbuminemia are the biggest patient-specific risk factors for being hospitalized. Our results indicate that chronic opioid use in CP has increased in the last 15 years. Given the risks and side effects of opioids, along with recent legislation that more strictly regulates dispensation, finding alternative pain management techniques is essential in maintaining good quality of life for these patients.
Published Version
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