Pain and Sedative Medication Use Among Individuals With Inflammatory Bowel Disease: A Nationwide Population-Based Cohort Study.

Abstract

BACKGROUND Individuals with inflammatory bowel disease (IBD) often experience pain, mood disturbances, and sleep disruption, which may lead to greater use of pain-relieving and sedative medications compared with the general population. These are associated with increased mortality, paradoxical worsening of pain, and inappropriate IBD treatment discontinuation. Chronic prescribing and co-prescribing increase the risk of respiratory depression, dependence, and overdose. METHODS Using Clinical Practice Research Datalink, a large nationally representative dataset, we examined the annual prevalence of total, chronic (> 90 days opioids; > 28 days sedatives), and co-prescribed opioids, gabapentinoids and sedatives in adults with incident IBD from January 2010 to December 2019. Multivariable regression identified predictors of chronic or co-prescribing. RESULTS Among 17,388 individuals, over 20% were prescribed a pain or sedative medication each year. Annual prevalence for opioids and gabapentinoids increased (13.6%-14% and 2.5%-5.6%, respectively) while sedative prevalence remained stable (8.4%). Chronic prescribing increased for strong opioids (3.6%-4.6%), weak opioids (3.6%-3.7%) and sedatives (4.2%-4.4%). Between 4.2% and 6.9% of individuals per year were co-prescribed opioids, gabapentinoids, and/or sedatives. Female sex, smoking, older age at diagnosis, Crohn's disease, and a diagnosis of inflammatory arthropathy, irritable bowel syndrome, fibromyalgia, or anxiety/depression were significantly associated with chronic and/or co-prescriptions of opioids or sedatives. CONCLUSION A substantial proportion of individuals with IBD are prescribed pain and sedative medications, including long-term and co-prescriptions. Identifying high-risk patients is essential to ensure they are prioritised for limited resources, such as psychological therapies, as alternatives to harmful prescriptions.