# Improving Pain Management and Opioid Safety for Patients with Cirrhosis

> **NIH NIH K23** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2021 · $189,037

## Abstract

Prescription opioid medications are a leading cause of opioid-related death and are particularly risky in patients
with liver cirrhosis. Cirrhosis affects four million people in the US and is most often due to alcohol or substance
use disorder (SUD)-mediated hepatitis C. In this population, prescription opioids are associated with decreased
access to life-saving transplantation and increased complications of liver disease, hospitalizations, and
mortality. Despite these risks, approximately half of all patients with cirrhosis are prescribed opioid medications
each year. This is likely because 80% of patients with cirrhosis have chronic pain and alternative pain
management strategies have not been designed for or tested in this population. Indeed, existing pain
management interventions designed for general populations do not address many of the specific issues facing
patients with cirrhosis such as their overall high symptom burden, contraindications to most common analgesic
medications, and underlying mental health and SUDs. The National Pain Strategy recommends using
behavioral interventions, specifically pain self-management interventions, to address chronic pain. However,
such interventions are most effective when they are designed to address the specific needs of the population
of interest. Therefore, the overarching research goal of this K23 award is to develop and test a behavioral
intervention for chronic pain for patients with cirrhosis. This goal will be achieved through the following Specific
Aims: Aim 1) To develop a theory-based behavioral intervention to improve pain and function for patients with
cirrhosis; and Aim 2) To conduct a randomized pilot trial of the intervention developed in Aim 1. Existing pain
self-management interventions will serve as a starting point for this work. Following the established steps of
Intervention Mapping (IM), a structured approach to developing theory-based behavioral interventions,
stakeholder input and semi-structured interviews will be integrated into a behavioral intervention for pain that
addresses the needs of patients with cirrhosis. The resulting intervention will be pilot tested in 40 patients with
cirrhosis and chronic pain. This research is significant because it aims to address the national opioid crisis in a
high-risk, understudied population. Furthermore, this approach may be applicable to other populations with
high rates of chronic pain and SUDs. This research is innovative because it will lead to the first intervention for
pain for this population. Dr. Shari Rogal is uniquely positioned to conduct this study, as she is a
gastroenterologist and transplant hepatologist with a research focus on studies of SUDs and pain in the
context of liver disease. Through this award Dr. Rogal will receive additional training in chronic pain science,
behavioral science, and behavioral clinical trials, as well as the support of a multidisciplinary mentoring team.
This K23 will thus allow her to develop...

## Key facts

- **NIH application ID:** 10126825
- **Project number:** 5K23DA048182-02
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Shari S Rogal
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $189,037
- **Award type:** 5
- **Project period:** 2020-04-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10126825

## Citation

> US National Institutes of Health, RePORTER application 10126825, Improving Pain Management and Opioid Safety for Patients with Cirrhosis (5K23DA048182-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10126825. Licensed CC0.

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