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The Assessment and Management of Pain in Cirrhosis

  • Management of Cirrhotic Patient (A Cardenas and P Tandon, Section Editors)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

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 are common in patients with cirrhosis. There are numerous contraindications and limitations when considering pharmacotherapy for analgesia in cirrhosis, specifically with nonsteroidal anti-inflammatory drugs 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.

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, USA

    Matthew Klinge, Mohannad Dugum & Shari Rogal

  2. Division of Pharmacy, VA Pittsburgh Healthcare System, Pittsburgh, USA

    Tami Coppler

  3. Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, USA

    Jane M. Liebschutz

  4. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, USA

    Ajay Wassan

  5. Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA

    Andrea DiMartini

  6. Department of Surgery, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Andrea DiMartini & Shari Rogal

  7. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 1 University Drive, Pittsburgh, PA, 15240, USA

    Shari Rogal

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  1. Matthew Klinge
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  2. Tami Coppler
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  3. Jane M. Liebschutz
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  4. Mohannad Dugum
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  5. Ajay Wassan
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  6. Andrea DiMartini
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  7. Shari Rogal
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Correspondence to Shari Rogal.

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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.

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This article does not contain any studies with human or animal subjects performed by any of the authors

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The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

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This article is part of the Topical Collection on Management of Cirrhotic Patient

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Klinge, M., Coppler, T., Liebschutz, J.M. et al. The Assessment and Management of Pain in Cirrhosis. Curr Hepatology Rep 17, 42–51 (2018). https://doi.org/10.1007/s11901-018-0389-7

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