P1278 The use of pain and sedative medications among individuals with a diagnosis of Inflammatory Bowel Disease
Authors: Baillie S , Jayasooriya N , Blackwell J , Bottle A , Petersen I , Saxena S , Pollok R ,   POP-IBD
Published: January 2025

Background

Individuals with inflammatory bowel disease (IBD) frequently experience pain, poor sleep and anxiety even when disease activity is well controlled. A nationwide UK study showed that 42% individuals with IBD want help with pain and 56% want help with fatigue.(1) Unfortunately, pharmacological management of these symptoms is often inadequate and frequently associated with significant side effects, particularly when pain medications and sedatives are prescribed chronically or concurrently. Despite the risks, there is a lack of evidence regarding the trend in use of these medications in European IBD populations.

Methods

An extract of over 80,000 individuals with IBD was obtained from the general practice database "Clinical Practice Research Datalink" (CPRD) including details of prescriptions, diagnoses and demographics. Data from 1st January 2010 to 31st December 2019 was analysed to assess prescribing trends for opioids, gabapentinoids, benzodiazepines, and Z-drugs. We examined overall, chronic, and concurrent prescribing patterns. Chronic prescribing was defined as continuous use of opioids for more than 3 months, or Z-drugs and benzodiazepines for more than 4 weeks, in accordance with national guidelines.(2–4) Concurrent prescribing, assessed in 2-year intervals, was defined as overlapping prescriptions of opioids, gabapentinoids, Z-drugs, or benzodiazepines. Data were analysed using Stata 18 and R.

Results

Over the study period, the annual prevalence of gabapentinoids, and Z-drug use increased (2.5% to 5.5% and 3.3% to 3.4% respectively) while strong opioid (9.2%-8.5%), weak opioid (12.1%-9.9%) and benzodiazepine use (6.1%-5.6%) decreased (see Figure 1).

The annual prevalence of chronically prescribed medications in 2019 were 2.5% strong opioids, 3.4% weak opioids, 2.4% benzodiazepines and 1.8% Z-drugs.

Over 1 in 5 gabapentinoid prescriptions were concurrent with another pain or sedative medication; 17% with strong opioids, 6% benzodiazepines and 4% Z-drugs, while 18% of strong opioids, 18% Z-drugs and 18% benzodiazepines were concurrently prescribed with another pain medication or sedative (see Table 1).

Conclusion

Overall, prescribing rates of pain medications and sedatives in individuals with IBD remain concerning. While opioid use has dropped and sedative use is stable, gabapentinoid use has increased, and all are often co-prescribed. Chronic prescribing of these medications provides no clear benefit and poses significant risks. Future efforts should prioritise reducing chronic and concurrent prescribing of pain and sedative medications

References

1.J Crohns Colitis. 2023;17(Supplement_1):i130-i132. doi:10.1093/ecco-jcc/jjac190.0099

2.Sir Liam Donaldson. Chief Medical Officer’s Update. Department of Health; 2004:4. Accessed August 21, 2024. https://webarchive.nationalarchives.gov.uk/ukgwa/20120503095605/http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/CMOupdate/DH_4070172

3.Chronic Pain (Primary and Secondary) in over Sixteens: Assessment of All Chronic Pain and Management of Chronic Primary Pain. National Institute for Health and Care Excellence; 2021. https://www.nice.org.uk/guidance/ng193

4.Faculty of Pain Medicine. Surgery and Opioids: Best Practice Guidelines 2021. Published online March 2021.