Author information

• ¹Division of Rheumatology, University of Michigan, Ann Arbor.
• ²Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor.
• ³Chronic Pain and Fatigue Research Center, Anesthesiology Department, University of Michigan, Ann Arbor.

Abstract

Chronic pain is highly prevalent in patients with cirrhosis and is associated with poor health-related quality of life (HRQOL) 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 GI 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 non-pharmacologic therapies, to patients' needs.