Contemporary management of pain in cirrhosis: Toward precision therapy for pain

Chronic pain is highly prevalent in patients with cirrhosis and is associated with poor health-related quality of life and poor functional status. However, there is limited guidance on appropriate pain management in this population, and pharmacologic treatment can be harmful, leading to adverse outcomes, such as gastrointestinal bleeding, renal injury, falls, and hepatic encephalopathy. Chronic pain can be categorized mechanistically into three pain types: nociceptive, neuropathic, and nociplastic, each responsive to different therapies. By discussing the identification, etiology, and treatment of these three mechanistic pain descriptors with a focus on specific challenges in patients with cirrhosis, we provide a framework for better tailoring treatments, including nonpharmacologic therapies, to patients' needs.

Automated summary

Chronic pain is common in patients with cirrhosis and has a negative impact on their health-related quality of life and functional status. However, there is limited guidance on appropriate pain management in this population and pharmacologic treatment may lead to harmful outcomes. By categorizing chronic pain into different mechanistic types and discussing the identification, etiology, and treatment of these types, including nonpharmacologic therapies, we provide a framework for tailoring treatments to the specific challenges faced by patients with cirrhosis.