Older Adult-Onset of Inflammatory Bowel Diseases Is Associated With Higher Utilization of Analgesics: A Nationwide Cohort Study

Abstract

Introduction: Patients with inflammatory bowel diseases (IBD) commonly require analgesic medications to treat pain, which may be associated with complications. We examined trends of analgesic use according to age of IBD onset. Methods: This nationwide cohort study included adults diagnosed with IBD between 1996-2021 in Denmark. Patients were stratified according to their age of IBD onset: 18-39 years (young adult), 40-59 years (adult), and 60+ years (older adult). We examined the proportion of patients who received prescriptions for analgesic medications within 1 year after IBD diagnosis: strong opioids, tramadol, codeine, non-steroidal anti-inflammatory drugs (NSAIDs), and paracetamol. Multivariable logistic regression was performed to examine the association between age of IBD onset with strong opioid prescriptions and the composite of strong opioid/tramadol/codeine prescriptions. Results: We identified 54,216 adults with IBD. Among these, 25,184 (46.5%) were young adults, 16,106 (29.7%) were adults, and 12,926 (23.8%) were older adults at IBD onset. Older adults most commonly received analgesic prescriptions of every class. Between 1996-2021, strong opioid, tramadol, and codeine prescriptions were stable while paracetamol prescriptions increased and NSAID prescriptions decreased. After multivariable logistic regression, older adults had higher adjusted odds of receiving strong opioid prescriptions (aOR 1.95, 95%CI 1.77-2.15) and the composite of strong opioid/tramadol/codeine prescriptions (aOR 1.93, 95%CI 1.81-2.06) within 1 year after IBD diagnosis compared to adults. Discussion: In this nationwide cohort, older adults most commonly received analgesic prescriptions within 1 year after IBD diagnosis. Additional research is needed to examine the etiology and sequelae of increased analgesic prescribing to this demographic.

The use of opioids nine months after surgery for Crohn's disease – a nationwide cohort study

“…3 A recent study from Denmark showed that the use of opioids had not declined during the first year after IBD diagnosis between 1996 and 2021. 11 This applied to all age groups, however, elderly with IBD more commonly received analgesic prescriptions of every class and had a two-fold increased odds of receiving strong opioid prescriptions after IBD diagnosis when compared to adults. Corroborating these data are our findings of considerable opioid use among the elderly undergoing surgery for CD both prior to and 9 months after surgery.…”

“…9,10 Additionally, analgesic use appears to vary by age group in the IBD population. 11 Regarding pain management in IBD, several questions are still left to be answered -which subpopulations of patients with IBD are at risk for chronic pain and chronic use of analgesics and what are the clinical consequences in these patients? Unfortunately, at present, there is a lack of specific strategies for pain management in IBD and a lack of clinical guidelines.…”