Even though many patients with inflammatory bowel disease (IBD) need pain management, epidemiological data on the use of analgesics in this population are scarce.

Rahul S. Dalal, MD, MPH, a gastroenterologist and IBD specialist in the Division of Gastroenterology, Hepatology and Endoscopy at Brigham and Women’s Hospital, and colleagues recently completed a nationwide study of the use of analgesics for IBD according to age at disease onset.

In The American Journal of Gastroenterology, they report individuals with older adult–onset of IBD were more commonly prescribed analgesic medications, compared with other age groups, within one year after IBD diagnosis. They were also less likely to receive IBD-specific biologic medications.

Methods

The team studied 54,216 adults in Denmark who had onset of ulcerative colitis or Crohn’s disease between January 1, 1996, and May 29, 2021:

• 25,184 (46.5%) were classified as “young adults” (18–39 years old)
• 16,106 (29.7%) were “adults” (40–59 years old)
• 12,926 (23.8%) were “older adults” (≥60 years old)

The study drew on patient-level data from three Danish registries:

• The Danish Civil Registration System—information about sex and dates of birth, death, and emigration

• The Danish National Patient Registry—information about outpatient visits and hospital admissions/discharges, including diagnosis/procedure codes

• The Danish National Prescription Registry—information about inpatient and outpatient prescriptions filled; notably, nonsteroidal anti-inflammatory drugs (NSAIDS) are sold by prescription in Denmark, except low-dose (200 mg) ibuprofen can be obtained over the counter in a limited quantity of 20 tablets

The Danish registries are assumed to have complete data for all individuals starting at birth, so the study described analgesic use over 25 years with no missing data or loss to follow-up. Individuals near the end of life, those with recent diagnoses of malignancy or musculoskeletal conditions, and those with analgesic prescriptions before IBD diagnosis were excluded.

Age of Onset and Use of Any Analgesic

For each analgesic class, prescriptions in the first year after IBD diagnosis were most common among older adults:

• Strong opioids—8.3% of older adults, 4.4% of adults, and 1.5% of young adults
• Tramadol—11.7%, 6.8% and 3.1%
• Codeine—5.7%, 3.6% and 1.4%
• NSAIDs—10.6%, 8.6% and 3.5%
• Acetaminophen—25.7%, 10.7% and 3.1%

The strong opioids considered were oxycodone, hydromorphone, morphine, fentanyl, meperidine, and ketobemidone.

Even after the exclusion of individuals who underwent IBD surgery during the first year after diagnosis, a known risk factor for opioid use, analgesic prescriptions were more common among older adults than the other age groups.

Age of Onset and Use of Opioids

Within one year after IBD diagnosis, compared with the adult group, older adults had higher odds of receiving opioid prescriptions:

• Strong opioid prescriptions—adjusted OR (aOR), 1.95; 95% CI, 1.77–2.15
• Composite endpoint of strong opioid/tramadol/codeine prescriptions—aOR, 1.93; 95% CI, 1.81–2.06

Younger adults had lower odds compared with the adult group:

• Strong opioid prescriptions—aOR, 0.30; 95% CI, 0.26–0.34
• Composite endpoint—aOR, 0.36; 95% CI, 0.34–0.39

Is Older Adult–onset IBD Inappropriately Treated?

Another finding in this study was that older adults were less commonly prescribed biologic therapies within one year after IBD diagnosis (3.3% compared with 6.5% of adults and 13.4% of younger adults). In light of the findings of greater analgesic use among older adults, medical treatment may target pain symptoms rather than the underlying disease process.

The rationale for increased analgesic prescribing to older adults and its sequelae deserve investigation.