Analgesic Use in Patients with Mild Inflammatory Bowel Disease-A Nationwide Cohort Study Based on Prescription Data

Background: In patients with Crohn's disease (CD) and ulcerative colitis (UC) disease severity and activity have been associated with pain. Data on analgesic use in patients with mild disease, however, are limited. We examined prescribed analgesics in mild CD and UC. Methods: In this cohort study, based on nationwide Danish prescription data, we identified incident patients (1996 through 2020) with mild CD (N = 5348) and UC (N = 15,622). Mild disease was defined by absence of advanced medical treatments, and no surgeries, in the period of 3.5 years after the diagnosis. We examined opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and paracetamol. We also examined opioid use in CD compared to UC. Results: In mild CD, the proportions of patients using analgesics in 2001 and 2020 were: strong/weak opioids 9.1% and 10.0%, chronic opioids 3.2% and 4.1%, NSAIDs 12.4% and 8.5%, and paracetamol 4.0% and 21.7%, respectively. In mild UC, the corresponding proportions in 2001 and 2020 were: strong/weak opioids 6.2% and 7.2%, chronic opioids 2.9% and 2.7%, NSAIDs 12.7% and 8.3%, and paracetamol 2.4% and 19.5%, respectively. The adjusted OR for chronic opioid use in mild CD relative to mild UC was 1.61 (95% CI 1.41-1.85). Conclusions: We found a widespread use of prescribed analgesics in patients with mild IBD. The trends across two decades were similar for both diseases: a steep increase in paracetamol, a modest decline in NSAIDs, a slight decline in weak opioids, but no decline in strong opioids. The risk of chronic opioid use was higher in mild CD than in mild UC. We suggest that patients with mild disease may have pain issues that need to be managed clinically.