Mayo Clinic Proceedings: Review of pain management practices for cirrhosis patients

May 26, 2010

In the May issue of Mayo Clinic Proceedings, physician experts review current practices for pain management in cirrhotic patients. The physician experts reviewed all current literature available on PubMed and MEDLINE with no limits in the search to recommend a uniform and practical guide to approaching analgesia in the cirrhotic patients.

Cirrhosis is a substantial public health problem, accounting for approximately 770,000 deaths annually and, according to autopsy studies, affecting 4.5 percent to 9.5 percent of the global population. "Pain management in patients with is a difficult clinical challenge for health care professionals, and few prospective studies have offered an evidence-based approach," says Kymberly Watt, M.D., Department of Gastroenterology and Hepatology at Mayo Clinic.

No evidence-based guidelines exist on the use of analgesics in patients with liver disease and cirrhosis, says Dr. Watt. From her findings in the current literature, her recommendation for long-term acetaminophen use in cirrhotic patients (not actively ) is for reduced dosing at 2 to 3 grams per day. For short-term use or one-time dosing, patient should not exceed 4 grams total per day but the proposed new FDA guidelines (yet to be finalized) may recommend a maximum daily dosage of 2.6 grams per day for anyone.

In addition, the review article states that NSAIDs (nonsteroidal anti-inflammatory drugs) and opioids may be used in patients with without cirrhosis. "NSAIDs should be avoided in those with both compensated and decompensated cirrhosis, primarily because of the risk of due to prostaglandin inhibition," says Dr. Watt.

"When appropriate, anticonvulsants and antidepressants are options worthy of exploration in chronic neuropathic in patients with advanced liver disease. Diligent follow-up for toxicity, adverse effects and complications is necessary," adds Dr. Watt.

"In patients with end-stage liver disease, adverse events from analgesics are frequent, potentially fatal and often avoidable. This review underscores the scarcity of prospective studies that have assessed the safety of various analgesics in patients with advanced hepatic dysfunction," says Dr. Watt.

Explore further: NY and NJ say they will require Ebola quarantines

add to favorites email to friend print save as pdf

Related Stories

Noninvasive tests for cirrhosis may help to avoid liver biopsy

Oct 01, 2007

Newer ultrasound and magnetic resonance (MR) imaging tests yield encouraging initial results in diagnosing fibrosis (scarring) and cirrhosis of the liver, according to three studies in the October issue of the journal Clinical Ga ...

Mayo Clinic seeks new therapies for alcoholic hepatitis

Dec 01, 2008

A new study from Mayo Clinic finds the use of the drug therapy etanercept ineffective in treating alcoholic hepatitis, an acute inflammation of the liver caused by excessive consumption of alcohol. The results of the study ...

New study finds 'it's never too late to stop drinking'

Apr 16, 2009

Where there is life there is hope and it is never too late to stop drinking, even with the most severe case of alcohol-related liver disease, according to new research from the University of Southampton.

Recommended for you

NY and NJ say they will require Ebola quarantines

2 hours ago

The governors of New Jersey and New York on Friday ordered a mandatory, 21-day quarantine for all doctors and other arriving travelers who have had contact with Ebola victims in West Africa.

WHO: Mali case may have infected many people

6 hours ago

The World Health Organization says a toddler who brought Ebola to Mali was bleeding from her nose during her journey on public transport and may have infected many people.

Two US nurses are declared cured of Ebola

8 hours ago

Two American nurses were declared cured of Ebola on Friday, and one was healthy enough to leave the hospital and meet President Barack Obama for a hug.

User comments : 0