Factors Associated with Frequent Opioid Use in Children with Acute Recurrent and Chronic Pancreatitis

Emily R. Perito, Tonya M. Palermo, John F. Pohl, Maria Mascarenhas, Maisam Abu-El-Haija, Bradley Barth, Melena D. Bellin, Douglas S. Fishman, Steven Freedman, Cheryl Gariepy, Matthew Giefer, Tanja Gonska, Melvin B. Heyman, Ryan W. Himes, Sohail Z. Husain, Tom Lin, Quin Liu, Asim Maqbool, Brian McFerron, Veronique D. MorinvilleJaime D. Nathan, Chee Y. Ooi, Sue Rhee, Sarah Jane Schwarzenberg, Uzma Shah, David M. Troendle, Steven Werlin, Michael Wilschanski, Yuhua Zheng, Miriam Bridget Zimmerman, Mark Lowe, Aliye Uc

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


OBJECTIVES: The aim of the study was to understand the association of frequent opioid use with disease phenotype and pain pattern and burden in children and adolescents with acute recurrent (ARP) or chronic pancreatitis (CP).

METHODS: Cross-sectional study of children <19 years with ARP or CP, at enrollment into the INSPPIRE cohort. We categorized patients as opioid "frequent use" (daily/weekly) or "nonfrequent use" (monthly or less, or no opioids), based on patient and parent self-report.

RESULTS: Of 427 children with ARP or CP, 17% reported frequent opioid use. More children with CP (65%) reported frequent opioid use than with ARP (41%, P = 0.0002). In multivariate analysis, frequent opioid use was associated with older age at diagnosis (odds ratio [OR] 1.67 per 5 years, 95% confidence interval [CI] 1.13-2.47, P = 0.01), exocrine insufficiency (OR 2.44, 95% CI 1.13-5.24, P = 0.02), constant/severe pain (OR 4.14, 95% CI 2.06-8.34, P < 0.0001), and higher average pain impact score across all 6 functional domains (OR 1.62 per 1-point increase, 95% CI 1.28-2.06, P < 0.0001). Children with frequent opioid use also reported more missed school days, hospitalizations, and emergency room visits in the past year than children with no frequent use (P < 0.0002 for each). Participants in the US West and Midwest accounted for 83% of frequent opioid users but only 56% of the total cohort.

CONCLUSIONS: In children with CP or ARP, frequent opioid use is associated with constant pain, more healthcare use, and higher levels of pain interference with functioning. Longitudinal and prospective research is needed to identify risk factors for frequent opioid use and to evaluate nonopioid interventions for reducing pain and disability in these children.

Original languageEnglish (US)
Pages (from-to)106-114
Number of pages9
JournalJournal of pediatric gastroenterology and nutrition
Issue number1
StatePublished - Jan 1 2020

Bibliographical note

Funding Information:
M.L. is on the Board of Directors of the National Pancreas Foundation; receives royalties from Millipore Inc and UpToDate. T.G. received a research grant from Vertex Pharmaceuticals and she is a consultant for Cystic Fibrosis Foundation. S.Z.H. has equity in Prevcon, LLC. J.P. is on the speaker’s bureau for Medical Education Resources, Inc. M.B. is a consultant for ARIEL Precision Medicine and receives research support from ViaCyte and Dexcom. C.Y.O. is a consultant for Vertex Pharmaceuticals. A.U. is a member of American Board of Pediatrics, Subboard of Pediatric Gastroenterology and a consultant for Cystic Fibrosis Foundation.

Funding Information:
Research reported in this publication was supported by National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award numbers R21 DK096327, U01 DK108334. INSPPIRE registry was developed by CTSA (2UL1 TR000442) and REDCap. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© ESPGHAN and NASPGHAN. All rights reserved.


  • chronic pain
  • opioids
  • pain medication
  • pancreatitis
  • pediatric


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