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Narcotic Use in Patients with Crohn's Disease

Cross, Raymond K., M.D1,2; Wilson, Keith T., M.D1,2; Binion, David G., M.D3

American Journal of Gastroenterology: October 2005 - Volume 100 - Issue 10 - p 2225–2229

OBJECTIVES Despite advances in treatment for Crohn's disease (CD), some patients suffer from chronic pain. We sought to characterize the prevalence of narcotic use and contributing factors in CD patients at a referral center.

METHODS A retrospective analysis of 291 CD patients followed over a 5-yr period was performed. Clinical status was evaluated with the Harvey–Bradshaw index (HBI) of disease activity and the short inflammatory bowel disease questionnaire (SIBDQ).

RESULTS Narcotic use was identified in 13.1% of patients. Narcotic users were more likely to be female, 72%versus 49% (p = 0.01), had higher rates of disability, 15.4%versus 3.6% (p = 0.001), and a longer duration of disease, 17.0 versus 12.9 yr (p = 0.03). In addition, they took more medications 6.97 versus 4.7 (p < 0.001) and had a higher prevalence of neuropsychiatric drug use, 37%versus 19% (p = 0.01). CD patients receiving narcotics had worse disease activity (HBI 9.1 vs 5.0, p < 0.001) and diminished quality of life (SIBDQ 44.2 vs 51.6 (p = 0.04)). However, logistic regression analysis found that active disease [HBI score of ≥ 4 (OR 3.9)], polypharmacy [use of ≥ 5 drugs (OR 5.5)], and smoking (OR 2.8) were associated with narcotic use.

CONCLUSIONS Narcotic use may be an indicator of more severe disease since it is associated with increased disease activity and decreased quality of life. Factors correlating with narcotic use include smoking and PP. Our data emphasize the need for further work to characterize chronic pain in CD patients.

1Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland

2Veterans Affairs, Maryland Heath Care System, Baltimore, Maryland

3Department of Medicine, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin

Reprint requests and correspondence: Raymond K. Cross, M.D., Division of Gastroenterology and Hepatology, University of Maryland Medical Center, 22 South Greene Street, N3W62, Baltimore, MD 21201.

Received January 14, 2005; accepted March 22, 2005.

© The American College of Gastroenterology 2005. All Rights Reserved.
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