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J Pediatr Gastroenterol Nutr. 2019 Sep 20. doi: 10.1097/MPG.0000000000002502. [Epub ahead of print]

Factors Associated With Frequent Opioid Use in Children With Acute Recurrent and Chronic Pancreatitis.

Author information

1
Department of Pediatrics, University of California San Francisco, San Francisco, CA.
2
Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA.
3
Department of Pediatrics, University of Utah, Salt Lake City, UT.
4
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
5
Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
6
Department of Pediatrics, University of Texas Southwestern, Dallas, TX.
7
Department of Pediatrics, University of Minnesota, Minneapolis, MN.
8
Department of Pediatrics, Texas Children's Hospital, Houston, TX.
9
Harvard University, Boston, MA.
10
Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
11
Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, ON, Canada.
12
Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA.
13
Department of Pediatrics, Cedars-Sinai, Los Angeles, CA.
14
Department of Pediatrics, Indiana University, Indianapolis, IN.
15
Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.
16
Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
17
School of Women's and Children's Health, Medicine, University of New South Wales, New South Wales, Sydney, Australia.
18
Department of Pediatrics, Massachusetts General Hospital, Boston, MA.
19
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
20
Hadassah University, Jerusalem, Israel.
21
Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
22
Department of Biostatistics, University of Iowa, Iowa City, IA.
23
Department of Pediatrics, Washington University, St. Louis, MO.
24
Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA.

Abstract

OBJECTIVES:

The aim of the study was to understand the association of frequent opioid use with disease phenotype and pain pattern and burden in children and adolescents with acute recurrent (ARP) or chronic pancreatitis (CP).

METHODS:

Cross-sectional study of children <19 years with ARP or CP, at enrollment into the INSPPIRE cohort. We categorized patients as opioid "frequent use" (daily/weekly) or "nonfrequent use" (monthly or less, or no opioids), based on patient and parent self-report.

RESULTS:

Of 427 children with ARP or CP, 17% reported frequent opioid use. More children with CP (65%) reported frequent opioid use than with ARP (41%, P = 0.0002). In multivariate analysis, frequent opioid use was associated with older age at diagnosis (odds ratio [OR] 1.67 per 5 years, 95% confidence interval [CI] 1.13-2.47, P = 0.01), exocrine insufficiency (OR 2.44, 95% CI 1.13-5.24, P = 0.02), constant/severe pain (OR 4.14, 95% CI 2.06-8.34, P < 0.0001), and higher average pain impact score across all 6 functional domains (OR 1.62 per 1-point increase, 95% CI 1.28-2.06, P < 0.0001). Children with frequent opioid use also reported more missed school days, hospitalizations, and emergency room visits in the past year than children with no frequent use (P < 0.0002 for each). Participants in the US West and Midwest accounted for 83% of frequent opioid users but only 56% of the total cohort.

CONCLUSIONS:

In children with CP or ARP, frequent opioid use is associated with constant pain, more healthcare use, and higher levels of pain interference with functioning. Longitudinal and prospective research is needed to identify risk factors for frequent opioid use and to evaluate nonopioid interventions for reducing pain and disability in these children.

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