Digestive Diseases and Sciences

, Volume 58, Issue 10, pp 2976–2985

Pain and Opioid Use in Chronic Liver Disease

  • Shari S. Rogal
  • Daniel Winger
  • Klaus Bielefeldt
  • Eva Szigethy
Original Article

DOI: 10.1007/s10620-013-2638-5

Cite this article as:
Rogal, S.S., Winger, D., Bielefeldt, K. et al. Dig Dis Sci (2013) 58: 2976. doi:10.1007/s10620-013-2638-5



Pain is common in patients with liver disease, difficult to treat, and poorly understood.


The aim of this study was to determine factors associated with pain and prescription opioid use in a large cohort of patients with confirmed chronic liver disease.


This was a retrospective cohort study of consecutive patients with chronic liver disease visiting a tertiary-care hepatology clinic. Pain was determined by self-report and rated numerically from 0 to 10. Symptoms of mood and sleep disorders and emotional distress were based on a symptom checklist. Etiology and stage of liver disease and use of prescribed opioids were abstracted from the electronic medical record. Logistic regression was used to establish factors associated with pain and prescription opioid use.


Among 1,286 patients with chronic liver disease, 34 % had pain and 25 % used opioids. The strongest predictor of pain in multivariate modeling was emotional distress (OR 3.66, 95 % CI 2.40–5.64), followed by non-white race (OR 1.87, 95 % CI 1.24–2.79), mood symptoms (OR 1.47, 95 % CI 1.04–2.07), sleep disturbance/fatigue (OR 1.70, 95 % CI 1.24–2.32), and advanced liver disease (Child class B: OR 1.73, 95 % CI 1.15–2.60; Child class C: OR 2.78, 95 % CI 1.49–5.24) compared to no cirrhosis. Emotional distress, mood-related symptoms, and advanced liver disease were also significant predictors of prescription opioid use, as were age, nicotine use, and etiology of liver disease.


This large cohort study demonstrates the high prevalence of pain and opioid use in chronic liver disease. While disease variables contribute to pain, psychological symptoms were most strongly associated with pain and opioid use, providing rationale and target for therapeutic interventions.


Narcotics Cirrhosis Pain management Psychosocial 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Shari S. Rogal
    • 1
  • Daniel Winger
    • 2
  • Klaus Bielefeldt
    • 1
  • Eva Szigethy
    • 3
  1. 1.Division of Gastroenterology, Hepatology, and NutritionUniversity of PittsburghPittsburghUSA
  2. 2.Clinical and Translational Science InstituteUniversity of PittsburghPittsburghUSA
  3. 3.Department of PsychiatryUniversity of PittsburghPittsburghUSA

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