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Pain Management of Budd Chiari Syndrome in the Primary Care Setting: A Case Study
Pilar Z Murphy1, Jimiece Thomas1, Taylor P McClelland1
1Samford University McWhorter School of Pharmacy.
Insights
Budd Chiari Syndrome (BCS) pain management lacks guidelines. Tramadol effectively controlled pain in a BCS patient awaiting a TIPS procedure, highlighting the need for outpatient pain management strategies.
Area of Science:
- Hepatology
- Pain Management
- Gastroenterology
Background:
- Budd Chiari Syndrome (BCS) is a rare hepatic venous obstruction impacting liver blood flow and causing ascites.
- Established treatments exist for BCS complications, but specific pain management guidelines are absent.
- Abdominal pain is a frequent symptom in BCS patients, necessitating effective management strategies.
Observation:
- A 22-year-old female with BCS experienced abdominal pain while awaiting a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
- Standard pain management guidelines for BCS were unavailable.
- Concurrent conditions and medications (acute liver injury, portal venous thrombosis, apixaban) limited analgesic choices.
Findings:
- Tramadol (25 mg) was selected for pain management due to its lower abuse potential compared to other opioids.
- The patient achieved adequate pain control with tramadol without complications.
- A successful TIPS procedure was performed one month after initiating tramadol.
Implications:
- Developing outpatient pain management guidelines for BCS is crucial for improving patient quality of life.
- Such guidelines would assist primary care providers in safely and effectively managing BCS-associated pain.
- This case underscores the importance of individualized pain management in rare diseases like BCS.
Introduction:
Budd Chiari Syndrome (BCS) is a very rare disease affecting approximately 1 in 100,000 people in the general population. It is caused by an obstruction of the hepatic veins leading to blood backing up in the liver. Treatment options to improve hepatic blood flow and relieve ascites are well documented. However, there are no established guidelines or treatment preferences for pain associated with BCS while patients are awaiting other treatment options.
Case:
A 22-year-old African American female was diagnosed with Budd Chiari Syndrome. The initial attempt at a transjugular intrahepatic portosystemic shunt (TIPS) procedure failed. While awaiting a second attempt at the procedure, the patient presented to her primary care provider complaining of abdominal and right upper quadrant pain. Treatment guidelines were searched for acute pain management options; however, no BCS pain management guidelines exist.
Discussion:
Individuals with BCS often present with abdominal pain, however, no guidelines outlining analgesic options in BCS exists. Acetaminophen, NSAIDs, and opioids are commonly used prescription medications for moderate to severe pain. Acetaminophen use was not considered due to acute liver injury and portal venous thrombosis. Anticoagulation with apixaban prevented concurrent use with NSAIDs. Opioid medications combined with acetaminophen were excluded to minimize exacerbating the liver injury. Tramadol 25 mg was chosen due to its lower abuse profile than other opioid analgesics, and was initiated for pain management.
Conclusion:
The patient reported adequate pain control with tramadol, tolerated the medication with no complications, and underwent a successful TIPS procedure one month later. Abdominal pain is a common symptom of BCS and needs to be effectively managed. Guidelines on treating pain associated with BCS in the outpatient setting would improve quality of life for patients and provide guidance to primary care providers requiring direction on how to address pain associated with Budd Chiari Syndrome safely and adequately.
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