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

Emily R. Perito, Tonya M. Palermo, John F. Pohl, Maria Mascarenhas, Maisam Abu-El-Haija, Bradley Barth, Melena D. Bellin, Douglas S. Fishman, Steven Freedman, Cheryl Gariepy, Matthew Giefer, Tanja Gonska, Melvin B. Heyman, Ryan W. Himes, Sohail Z. Husain, Tom Lin, Quin Liu, Asim Maqbool, Brian McFerron, Veronique D. MorinvilleJaime D. Nathan, Chee Y. Ooi, Sue Rhee, Sarah Jane Schwarzenberg, Uzma Shah, David M. Troendle, Steven Werlin, Michael Wilschanski, Yuhua Zheng, M. Bridget Zimmerman, Mark Lowe, Aliye Uc

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of pediatric gastroenterology and nutrition
DOIs
StateAccepted/In press - Jan 1 2019

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Chronic Pancreatitis
Opioid Analgesics
Pain
Odds Ratio
Confidence Intervals
Midwestern United States
Self Report
Hospital Emergency Service
Hospitalization
Multivariate Analysis
Cross-Sectional Studies
Delivery of Health Care
Phenotype

Keywords

  • chronic pain
  • opioids
  • pain medication
  • pancreatitis
  • pediatric

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Cite this

Factors Associated with Frequent Opioid Use in Children with Acute Recurrent and Chronic Pancreatitis. / Perito, Emily R.; Palermo, Tonya M.; Pohl, John F.; Mascarenhas, Maria; Abu-El-Haija, Maisam; Barth, Bradley; Bellin, Melena D.; Fishman, Douglas S.; Freedman, Steven; Gariepy, Cheryl; Giefer, Matthew; Gonska, Tanja; Heyman, Melvin B.; Himes, Ryan W.; Husain, Sohail Z.; Lin, Tom; Liu, Quin; Maqbool, Asim; McFerron, Brian; Morinville, Veronique D.; Nathan, Jaime D.; Ooi, Chee Y.; Rhee, Sue; Schwarzenberg, Sarah Jane; Shah, Uzma; Troendle, David M.; Werlin, Steven; Wilschanski, Michael; Zheng, Yuhua; Zimmerman, M. Bridget; Lowe, Mark; Uc, Aliye.

In: Journal of pediatric gastroenterology and nutrition, 01.01.2019.

Research output: Contribution to journalArticle

Perito, ER, Palermo, TM, Pohl, JF, Mascarenhas, M, Abu-El-Haija, M, Barth, B, Bellin, MD, Fishman, DS, Freedman, S, Gariepy, C, Giefer, M, Gonska, T, Heyman, MB, Himes, RW, Husain, SZ, Lin, T, Liu, Q, Maqbool, A, McFerron, B, Morinville, VD, Nathan, JD, Ooi, CY, Rhee, S, Schwarzenberg, SJ, Shah, U, Troendle, DM, Werlin, S, Wilschanski, M, Zheng, Y, Zimmerman, MB, Lowe, M & Uc, A 2019, 'Factors Associated with Frequent Opioid Use in Children with Acute Recurrent and Chronic Pancreatitis', Journal of pediatric gastroenterology and nutrition. https://doi.org/10.1097/MPG.0000000000002502
Perito, Emily R. ; Palermo, Tonya M. ; Pohl, John F. ; Mascarenhas, Maria ; Abu-El-Haija, Maisam ; Barth, Bradley ; Bellin, Melena D. ; Fishman, Douglas S. ; Freedman, Steven ; Gariepy, Cheryl ; Giefer, Matthew ; Gonska, Tanja ; Heyman, Melvin B. ; Himes, Ryan W. ; Husain, Sohail Z. ; Lin, Tom ; Liu, Quin ; Maqbool, Asim ; McFerron, Brian ; Morinville, Veronique D. ; Nathan, Jaime D. ; Ooi, Chee Y. ; Rhee, Sue ; Schwarzenberg, Sarah Jane ; Shah, Uzma ; Troendle, David M. ; Werlin, Steven ; Wilschanski, Michael ; Zheng, Yuhua ; Zimmerman, M. Bridget ; Lowe, Mark ; Uc, Aliye. / Factors Associated with Frequent Opioid Use in Children with Acute Recurrent and Chronic Pancreatitis. In: Journal of pediatric gastroenterology and nutrition. 2019.
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abstract = "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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T1 - Factors Associated with Frequent Opioid Use in Children with Acute Recurrent and Chronic Pancreatitis

AU - Perito, Emily R.

AU - Palermo, Tonya M.

AU - Pohl, John F.

AU - Mascarenhas, Maria

AU - Abu-El-Haija, Maisam

AU - Barth, Bradley

AU - Bellin, Melena D.

AU - Fishman, Douglas S.

AU - Freedman, Steven

AU - Gariepy, Cheryl

AU - Giefer, Matthew

AU - Gonska, Tanja

AU - Heyman, Melvin B.

AU - Himes, Ryan W.

AU - Husain, Sohail Z.

AU - Lin, Tom

AU - Liu, Quin

AU - Maqbool, Asim

AU - McFerron, Brian

AU - Morinville, Veronique D.

AU - Nathan, Jaime D.

AU - Ooi, Chee Y.

AU - Rhee, Sue

AU - Schwarzenberg, Sarah Jane

AU - Shah, Uzma

AU - Troendle, David M.

AU - Werlin, Steven

AU - Wilschanski, Michael

AU - Zheng, Yuhua

AU - Zimmerman, M. Bridget

AU - Lowe, Mark

AU - Uc, Aliye

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - chronic pain

KW - opioids

KW - pain medication

KW - pancreatitis

KW - pediatric

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