Pain Management in Patients with Cirrhosis; A Mini Narrative Literature Review with Evidence-Based Recommendations

Abstract

Cirrhosis is a significant public health concern, causing approximately 790,000 deaths annually. Despite the possibility of adverse effects from analgesics, which can be fatal and preventable, guidelines for their use in this setting do not exist, and there is a lack of research in this field. Thus, this review aims to summarize and analyze published data on different opioids in patients with liver cirrhosis to provide possible evidence-based guidelines for the safe use of opioids. Both compensated and decompensated patients should avoid NSAIDs. Because of the risk of hepatic encephalopathy, opioids must be avoided or used sparingly at low and infrequent doses. A long-term follow-up is required for toxicity, adverse effects, and complications of all pain relievers.