Multidimensional Experience of Pain in Adults With Cirrhosis: A Cross-sectional Survey Study

Background and Aims

Patients with liver disease report unrelieved pain. Exploring the multidimensional nature of pain provides insights into its burden and management needs in cirrhosis. This study explored biopsychosocial factors of pain and the relationship between pain intensity and liver disease severity.

Methods

A cross-sectional survey design was conducted at a Canadian ambulatory hepatology clinic in 2021. Eligible participants were ≥18 years with a documented the Model for End-stage Liver Disease with Sodium (MELD-Na) score. We report pain characteristics, self-care management, and pain interference using the Brief Pain Inventory. Multiple linear regression analyses examined the relationship between MELD-Na and pain intensity.

Results

Of 118 participants (98% response rate), 61.9% were male, 59 ± 11.8 years of age. Leading diagnoses were alcohol related (34.7%) and viral hepatitis (21.2%), and 89.8% had decompensated cirrhosis. The composite pain intensity mean score was 4 ± 2.4. Common pain sites included: abdomen (83.1%), lower legs (59.3%), and lower back (56.8%). Pain interference scores ranged from general activity 5.8 ± 3.1, walking ability 5.7 ± 3.3, and sleep 5.6 ± 3.6. Use of self-management strategies for pain was reported by 37.3%, primarily oral analgesics; no social or psychological strategies were reported. Multiple regression analysis indicated that pain intensity was associated with liver disease severity. MELD-Na 23–31 (β = 0.43), 21–22 (β = 0.28), and 17–20 (β = 0.19). Physical factors associated with pain intensity included ascites (β = 0.16) and edema (β = 0.28).

Conclusion

We observed moderate pain and pain-related activity interference in adults with cirrhosis. Ascites, edema, and liver disease severity were associated with pain intensity. More research is needed to explore biopsychosocial pain management interventions for this population.