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HISPANIC PATIENTS WITH IBD WHO UNDERWENT BOWEL RESECTION ARE LESS LIKELY TO RECEIVE ALL-CAUSE OPIOID AND NON-OPIOID AGENTS USED IN MULTIMODAL PAIN MANAGEMENT
Nofel Iftikhar
*1, Tomas Potlach
2, Rafena Boyd
2, Jeremy Grant
2, Chelsea Salmon
2, Bishal Paudel
2, Johan Nordenstam
3, Naueen A. Chaudhry
2, Ellen M. Zimmermann
21University of Florida College of Liberal Arts and Sciences, Gainesville, FL; 2University of Florida Department of Medicine, Gainesville, FL; 3University of Florida Department of Surgery, Gainesville, FL
Background: Effective pain management is critical for recovery after bowel resections and during inflammatory bowel disease (IBD) exacerbations. Due to opioid-related adverse effects, including impaired gastrointestinal motility and dependence, multimodal strategies incorporating non-opioid agents like acetaminophen, antispasmodics, gabapentinoids, nonsteroidal anti-inflammatory drugs (NSAIDs), and tricyclic antidepressants (TCAs) are recommended. However, NSAIDs are rarely used in IBD populations due to epithelial integrity damage. We studied disparities in pain medication use across demographic groups using a large database that includes Medicaid and robust patient-level electronic health record data from public and private health care systems in the southeastern US.
Methods: A retrospective analysis (October 2015–October 2024) utilized the Informatics for Integrating Biology and the Bedside (i2b2) tool and OneFlorida Data Trust. Patients with >2 ICD- 10 CM codes for Crohn’s disease (CD) or ulcerative colitis (UC) were identified. Bowel resections were determined using CPT codes for enterectomies and colectomies. Medications, which were identified using RXNORM codes, assessed included opioids (weak/strong), NSAIDs, gabapentin/pregabalin, antispasmodics, TCAs, and SSRIs.
Results: Among 70,654 IBD patients, non-Hispanic whites (NHW) comprised 49.4% (34,922), Hispanics 16.2% (11,457), and non-Hispanic blacks (NHB) 11.9% (8,431). Of these, 3.3% (2,366) underwent bowel resections, with NHW patients comprising 53.6% (1,270), NHB 16.8% (399), and Hispanics 16.4% (388). NHB patients had higher odds of undergoing resection than NHW patients (OR 1.32, 95% CI [1.17, 1.48], p<0.0001), while Hispanic patients had the same likelihood of surgery as NHW patients (p=0.211).
Post-resection analyses revealed racial/ethnic disparities in pain management. Hispanic patients were less likely than NHW patients to use weak opioids (OR 0.56, 95% CI [0.42, 0.74], p<0.0001), strong opioids (OR 0.41, 95% CI [0.33, 0.52], p<0.0001), gabapentin/pregabalin (OR 0.70, 95% CI [0.54, 0.90], p=0.005), antispasmodics (OR 0.73, 95% CI [0.54, 0.98], p=0.035), and SSRIs (OR 0.57, 95% CI [0.39, 0.82], p=0.002). TCA and NSAID use showed no significant differences. No significant differences in opioid, gabapentinoid, or antispasmodic use were observed between NHW and NHB patients, shown in Table 1.
Conclusion: These findings emphasize differences in all-cause pain management among IBD patients undergoing bowel resections. Hispanic patients consistently used fewer opioids and non-opioid pain medications compared to NHW patients, despite similar resection rates. Our findings may reflect differences in disease severity, pain perception, or healthcare access on the basis of ethnicity.
Table 1. Pain Medication Use Among Patients with IBD Who Underwent Bowel Resection from 2015-2024 Stratified by Race/Ethnicity (Total N=2366)*Weak opioids were defined as Codeine, Dihydrocodeine, Hydrocodone, Tramadol
**Strong opioids were defined as Alfentanil, Fentanyl, Hydromorphone, Levorphanol, Meperidine, Methadone, Morphine, Oxycodone, Oxymorphone, Propoxyphene, Remifentanil, Sufentanil, Tapentadol
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