Pain prescription trends and opioid disorder risk in chronic pancreatitis: A real-world data analysis from 2015 to 2024

BACKGROUND: Pain in chronic pancreatitis (CP) negatively impacts quality of life and healthcare utilization. This study characterized longitudinal analgesic prescribing trends, demographic differences, treatment pathways, and factors associated with opioid-related outcomes among patients with CP. METHODS: Using TriNetX, we identified adults with CP and assessed annual incidence and annual period prevalence of documented prescriptions from 2015 to 2024 for: NSAIDs/acetaminophen, opioids, benzodiazepines, neuropathic agents, and muscle relaxants. Treatment pathways and opioid-related outcomes were analyzed using Cox regression models adjusting for 39 covariates. RESULTS: Among 142,650 CP patients, the annual period prevalence of pain medication prescription increased from 41.24% to 58.80%, substantially exceeding the general population. NSAIDs/acetaminophen and opioid prescription prevalence showed the highest increases. Females exhibited higher use across all medication classes. Younger patients demonstrated higher initiation rates. Initial treatments mostly involved NSAIDs/acetaminophen and opioids, with frequent polypharmacy observed. 10% of patients developed opioid-related conditions, with significantly higher hazards among those with alcohol-related CP (opioid-related disorders: HR = 1.23, 95% CI 1.18-1.29, P < 0.001; opioid dependence: HR = 1.21, 95% CI 1.14-1.27, P < 0.001; opioid abuse: HR = 1.09, 95% CI: 1.02-1.18, p = 0.018) and those undergoing pancreatic surgery (opioid-related disorders: HR = 1.81, 95% CI 1.66-1.96, P < 0.001; opioid dependence: HR = 2.07, 95% CI: 1.89-2.27, p < 0.001). CONCLUSIONS: This large-scale analysis highlights substantial and increasing analgesic use in CP, marked by increasing opioid prescription burden, polypharmacy, and higher hazards of opioid-related disorders among patients with alcohol-related etiology or pancreatic surgery. These findings emphasize the need for more guideline-concordant, multimodal, and individualized pain management with careful monitoring of high-risk groups.