Study: Opioids Don't Reduce IBD Patients' Pain

Opioids do not appear to be effective in controlling the pain of patients hospitalized with inflammatory bowel disease (IBD) despite the drugs' widespread use for that purpose, according to a recent Cedars-Sinai study. The findings were based on analysis of pain levels reported by 57 patients during and after hospitalization.

A new study from Cedars-Sinai found that opioids do not appear to be effective in controlling pain in hospitalized IBD patients.

Opioids do not appear to be effective in controlling the pain of patients hospitalized with inflammatory bowel disease (IBD) despite the drugs' widespread use for that purpose, according to a recent Cedars-Sinai study. The findings were based on analysis of pain levels reported by 57 patients during and after hospitalization.

IBD, which includes Crohn's disease and ulcerative colitis, is a chronic condition of the digestive tract that can cause inflammation, pain and other problems, including severe diarrhea, fatigue, weight loss and malnutrition. Flare-ups of debilitating pain lower the quality of life for IBD patients and are a leading cause of hospitalization.

Over the past 10 years, hospitalizations of IBD patients have increased, with most patients being prescribed opioids or narcotics during their stay, said Gil Melmed, MD, co-director of the Inflammatory Bowel Disease Center at Cedars-Sinai and senior author of the study. And yet the effectiveness of such medications during hospitalization has been understudied, he explained.

This is an especially important issue because opioid medications are associated with increased risks of death, infection and longer hospital stays, Melmed added.

To conduct the study, the research team reviewed charts of all patients admitted for IBD at Cedars-Sinai over three months in 2017. They analyzed 57 records of patient-reported pain and opiate consumption and the average and maximum of each day's pain scores for each patient.

Analysis showed that despite significant opioid usage in the study group, pain scores did not meaningfully improve during hospitalization. Patients prescribed opioids had less than a one-point improvement (on a 10-point scale) in average pain scores between admission and discharge. They also showed no significant improvement in maximum pain scores during the first three days of hospitalization or during the entire period from admission to discharge.

Melmed said that the study had multiple important findings:

  • While most patients experienced pain during hospitalization, pain was not meaningfully improved by the time of discharge despite a high prevalence of opioid use.
  • Nearly half of all opioid users were prescribed opioids upon discharge.
  • Average pain scores were not influenced by gender, opioid use prior to admission or subsequent readmissions.
  • Both pain scores and opioid consumption were lower among older patients.
  • Opioid use prior to admission was not associated with higher opioid use during hospitalization.

Melmed, professor of Medicine, said more studies are warranted to further clarify the issues surrounding the use of narcotics for IBD and to identify effective strategies for reducing reliance on narcotics to treat pain in this patient population. He currently is leading a randomized controlled trial evaluating an opioid-sparing pain regimen compared to usual care in hospitalized patients with IBD.

The co-authors of the study, published in the journal Digestive Diseases and Sciences, were first author Sameer Berry, MD, a former medical resident at Cedars-Sinai who is now at the University of Michigan; and medical resident Will Takakura, MD, and Catherine Bresee, MS, senior biostatistician at the Biostatistics and Bioinformatics Core, both from Cedars-Sinai.

This research was IRB-exempt under protocol number 49946.