Clinical Markers of Crohn’s Disease Severity and Their Association With Opiate Use

Abstract

BackgroundThe safety of opiate use for patients with Crohn’s disease (CD) has long been a concern. The recent Crohn’s therapy, resource, evaluation, and assessment tool (TREAT) registry update has added to these concerns by demonstrating an association of opiate use with an increased risk of infection and death in CD. While the association is clear, the relationship of opiates to these negative outcomes is not. It is unknown whether opiates are a contributing factor to these negative outcomes or if their use is merely a marker of more severe disease. We hypothesized that opiate use is not harmful in CD but is a marker of disease severity and would be associated with commonly accepted clinical markers of severe CD such as early age at CD onset, disease duration, small intestinal involvement, a history of fistula or stricture, and lower quality of life (QOL) scores.MethodsData on CD history including pain medication usage were obtained from an interviewer directed survey of patients admitted to two tertiary care hospitals over a 2-year period. CD as the primary admitting diagnosis was not required. Active opiate use was defined by usage within the past month prior to admission.ResultsA total of 133 patients were approached to participate, of whom 108 consented to the survey, and 51 were active opiate users. Opiate using CD patients were more commonly smokers (22% vs. 3.45%, P < 0.010), had fistulas (40% vs. 22.4%, P < 0.048) and had a poorer quality of life score by short form inflammatory bowel disease questionnaire (mean 3.80 vs. 4.34, P < 0.036) than non-opiate users. No difference was found between opiate users and non-users for age of diagnosis, disease duration, or a history of strictures.ConclusionsThe study findings demonstrate that opiate use in CD is associated with markers of disease severity including fistulas, smoking, and lower QOL scores. The findings suggest that opiates may not be directly harmful to patients with CD, but may merely be another marker of disease severity. However, given opiates unproven benefits for long term CD pain control and risk of dependence, caution should still be exercised in their use.

Increasing Prescription of Opiates and Mortality in Patients With Inflammatory Bowel Diseases in England

“…Opiate use may be the cause or the effect of potential residual confounding factors. Previous studies have shown that opiate use in IBD is associated with fistulating disease and lower quality-of-life scores, 32 psychological illness, history of abuse, and substance abuse. 5 We were unable to control for these factors in our study.…”

Simple pain measures reveal psycho-social pathology in patients with Crohn’s disease

“…In all, we showed that the combined use of the pain questions from all 3 measures was a useful tool to assess the severity of pain in this CD cohort. The use of the pain questions from the Harvey-Bradshaw Index (similar to P-HBI with an additional question regarding the presence or absence of an abdominal mass) and the SIBDQ was previously reported in a study of opiate use in CD patients in the United States, but no attempt was made to standardize these respective scores[ 33 ].…”

“…Pain in CD is treated with a variety of analgesics including nonsteroidal anti-inflammatory drugs, opiates and more recently cannabis preparations[ 12 , 33 , 34 ]. Pain in CD patients is reported as often being undertreated, as was found in a recent large Swiss study[ 8 ].…”

All-cause hospitalizations for inflammatory bowel diseases: Can the reason for admission provide information on inpatient resource use? A study from a large veteran affairs hospital

“…Almost half of our cohort had psychiatric comorbidities, which might account for the higher prevalence of opioid use in this population. Prior studies have also shown that opioid use may be associated with more severe disease [ 9 , 10 ] and may be independently related to poor outcomes [ 9 ], although the cause or effect relationship remains to be determined. Finally, there are reports showing an overall increased prevalence of opioid use in veteran populations, although opiate use in veterans with IBD has not been previously studied [ 11 ].…”