Pain Management in the Cirrhotic Patient: The Clinical Challenge

Chandok, Natasha; Watt, Kymberly D. S.
May 2010
Mayo Clinic Proceedings;May2010, Vol. 85 Issue 5, p451
Academic Journal
Pain management in patients with cirrhosis is a difficult clinical challenge for health care professionals, and few prospective studies have offered an evidence-based approach, in patients with end- stage liver disease, adverse events from analgesics are frequent, potentially fatal, and often avoidable. Severe complications from analgesia in these patients include hepatic encephalopathy, hepatorenal syndrome, and gastrointestinal bleeding, which can result in substantial morbidity and even death, In general, acetaminophen at reduced dosing is a safe option. In patients with cirrhosis, nonsteroldai anti-inflammatory drugs should be avoided to avert renal failure, and opiates should be avoided or used sparingly, with low and infrequent dosing, to prevent encephalopathy, For this review, we searched the available literature using PubMed and MEDLINE with no limits,


Related Articles

  • FROM ACUTE PAIN TREATMENT (EUDYNIA) TO CHRONIC PAIN MANAGEMENT (MALDYNIA): CURRENT CONCEPTS. Barkin, Robert L. // University of Tennessee Advanced Studies in Pharmacy;2009, Vol. 6 Issue 2, p29 

    Recent approaches to pain management have increasingly emphasized treatment strategies that are based on the specific etiology of pain, the patient's individual analgesic needs and responses, the introduction of new analgesic medications and combination regimens, and a better understanding of...

  • Tramadol/Acetaminophen for Pain of Osteoarthritis Flares. Wellbery, Caroline // American Family Physician;1/1/2005, Vol. 71 Issue 1, p154 

    Focuses on a study which hypothesized that the combination of tramadol/acetaminophen would be safe and effective in a subset of elderly patients. Use of nonsteroidal anti-inflammatory drugs; Indication of the decreases in pain intensity and pain relief scores in the study.

  • Parecoxib and paracetamol for pain relief following minor day-stay gynaecological surgery. MOHAMAD, A. H.; McDONNELL, N. J.; BLOOR, M.; NATHAN, E. A.; PAECH, M. J. // Anaesthesia & Intensive Care;Jan2014, Vol. 42 Issue 1, p43 

    Paracetamol and non-steroidal anti-inflammatory drugs are often administered for postoperative analgesia. Dilatation and curettage, with or without hysteroscopy, is a common day-stay procedure that is associated with pain that is partly mediated by prostaglandins. This study aimed to investigate...

  • A review of over-the-counter pain medication. Lambert, Lynn // South African Pharmacist's Assistant;2014, Vol. 14 Issue 1, p27 

    The article discusses the safe and effective use of pain medications. It describes the different over the counter drugs such as paracetamol, aspirin and nonsteroidal anti-inflammatory drug indicated for headaches, joint and muscle pains, colds and flu. It describes the major elements in the...

  • Safe prescribing for pain relief. Knaggs, Roger // Practice Nurse;6/9/2006, Vol. 31 Issue 11, p20 

    The article presents a review of the range of oral analgesics available and the pharmacological principles of pain management. Paracetamol should be considered a first-line analgesic for most acute and chronic pain conditions. Nonsteroidal anti-inflammatory drugs (NSAID) have anti-inflammatory,...

  • Comparison of the effects of preoperative and intraoperative intravenous application of dexketoprofen on postoperative analgesia in septorhinoplasty patients: randomised double blind clinical trial. OZER, A. B.; ERHAN, O. L.; KELES, E.; DEMIREL, I.; BESTAS, A.; GUNDUZ, G. // European Review for Medical & Pharmacological Sciences;Nov2012, Vol. 16 Issue 13, p1828 

    BACKGROUND: Postoperative analgesia is important because it prevents the adverse effects of pain. To study the effect of preoperative or intraoperative application of dexketoprofen on postoperative analgesia and patient comfort in patients undergoing septorhinoplasty. PATIENTS AND METHODS: A...

  • Nonsteroidal Anti-Inflammatory Agents in Neonates. Morris, John L.; Rosen, David A.; Rosen, Kathleen R. // Pediatric Drugs;2003, Vol. 5 Issue 6, p385 

    The use of NSAIDs has become routine for adults and children in the management of pain. NSAIDs (other than aspirin [acetylsalicylic acid]) are also enjoying greater popularity as antipyretics since the recognition of Reye's syndrome's putative association with aspirin. In neonates, NSAIDs have...

  • Acceptability of Severe Pain Among Hospitalized Adults. Maroney, Catherine L.; Litke, Ann; Fischberg, Daniel; Moore, Carlton; Morrison, R. Sean // Journal of Palliative Medicine;Jun2004, Vol. 7 Issue 3, p443 

    Background: It is unclear why some hospitalized adults experiencing severe pain report that this degree of pain is acceptable to them. Methods: A 25% random sample of cognitively intact patients admitted to nine medical/surgical units in a New York City hospital were enrolled. Patients were...

  • American Geriatrics Society Issues New Guidelines on Pain Management.  // Mayo Clinic Women's Health Source;Nov2009, Vol. 13 Issue 11, p3 

    The article discusses the new guidelines on pain management issued by the American Geriatric Society (AGS) for older patients. AGS recommends that acetaminophen be considered as an initial therapy for mild to moderate pain in elders but should not exceed 4 grams a day. It suggests that because...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics