BACKGROUND Abdominal pain and opioid analgesic use are common in Crohn's disease (CD). AIMS We sought to identify factors associated with abdominal pain in CD and evaluate the impact of opioid analgesics on pain and quality-of-life scores in this setting. METHODS We performed a longitudinal cohort study using a prospective, consented IBD natural history registry from a single academic center between 2009 and 2013. Consecutive CD patients were followed for at least 1 year after an index visit. Data were abstracted regarding pain experience (from validated surveys), inflammatory activity (using endoscopic/histologic findings), laboratory studies, coexistent psychiatric disorders, medical therapy, opioid analgesic, and tobacco use. RESULTS Of 542 CD patients (56.6% women), 232 (42.8%) described abdominal pain. Individuals with pain were more likely to undergo surgery and were more frequently prescribed analgesics and/or antidepressants/anxiolytics. Elevated ESR (OR 1.79; 95%CI 1.11-2.87), coexistent anxiety/depression (OR 1.87; 95%CI 1.13-3.09), smoking (OR 2.08; 95%CI 1.27-3.40), and opioid use (OR 2.46; 95%CI 1.33-4.57) were independently associated with abdominal pain. Eighty patients (14.8%) were prescribed opioids, while 31 began taking them at or after the index visit. Patients started on opioids demonstrated no improvement in abdominal pain or quality-of-life scores on follow-up compared to patients not taking opioids. CONCLUSIONS Abdominal pain is common in CD and is associated with significant opioid analgesic utilization and increased incidence of anxiety/depression, smoking, and elevated inflammatory markers. Importantly, opioid use in CD was not associated with improvement in pain or quality-of-life scores. These findings reinforce the limitations of currently available analgesics in IBD and support exploration of alternative therapies.

中文翻译：

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阿片类镇痛药不能改善克罗恩病的腹痛或生活质量。

背景技术在克罗恩病（CD）中常见腹部疼痛和阿片类镇痛药的使用。目的我们试图确定与CD腹痛相关的因素，并评估在这种情况下阿片类镇痛药对疼痛和生活质量评分的影响。方法我们在2009年至2013年间使用单一学术中心的前瞻性，经同意的IBD自然史登记册进行了一项纵向队列研究。对连续性CD患者进行了至少一年的索引随访。提取有关疼痛经历（来自经验证的调查），炎症活动（使用内窥镜/组织学发现），实验室研究，并存的精神疾病，药物治疗，阿片类镇痛药和烟草使用的数据。结果542例CD患者（56.6％的女性）中有232例（42.8％）描述了腹痛。有疼痛感的人更容易接受手术，并且更频繁地使用止痛药和/或抗抑郁药/抗焦虑药。ESR升高（OR 1.79; 95％CI 1.11-2.87），焦虑/抑郁并存（OR 1.87; 95％CI 1.13-3.09），吸烟（OR 2.08; 95％CI 1.27-3.40），和阿片类药物使用（OR 2.46; 95％CI 1.33-4.57）与腹痛独立相关。八十名患者（14.8％）服用了阿片类药物，而31名患者在就诊时或之后开始服用阿片类药物。与不服用阿片类药物的患者相比，开始使用阿片类药物的患者在随访中腹部疼痛或生活质量得分没有改善。结论腹部疼痛在CD中很常见，并且与阿片类药物的有效镇痛作用以及焦虑/抑郁，吸烟和炎性标志物升高的发生率有关。重要的，CD中使用阿片类药物与疼痛或生活质量评分的改善无关。这些发现加强了IBD中目前可用的止痛药的局限性，并支持探索替代疗法。