Opioids Intertwined With Psychology: Hidden Effects in the Treatment of Patients With IBD

To the Editor,

We read with interest an article published in the latest issue of your journal entitled “Impact of Opioid Use on the Natural History of Inflammatory Bowel Disease: Prospective Longitudinal Follow-up Study.” Not only did this study provide valuable insights into the relationship between opioid use and mortality in patients with inflammatory bowel disease (IBD), but it also specifically found that reports of moderate or high somatization symptoms and the use of antidepressants or glucocorticoids were independently associated with opioid use.¹ This study is critical to the progression and long-term health implications for patients with IBD. Nevertheless, we have identified a number of areas that need to be further explored in order to refine this study.

First, the study selected a large sample of IBD patients from Leeds Teaching Hospitals, but is limited by geography, referral bias, and cultural socioeconomic factors that may affect the generalizability and representativeness of the results. As a tertiary referral center, the hospital is likely to receive more patients with severe conditions, making the results of the study biased toward severe conditions and not fully reflecting the status of the IBD patient population, and these factors may not be comparable across different regions. To enhance the generalizability and reliability of the findings, future studies should adopt a multicenter, cross-regional design to collect data from IBD patients in different regions to reveal geographical differences in the disease and guide the development of region-specific treatment strategies.² At the same time, uniform treatment standards and quality control indicators should be established to reduce treatment differences between geographic regions and ensure treatment consistency. In addition, studies need to consider the impact of cultural and socioeconomic factors on patient treatment adherence and disease outcomes, especially in regions with diverse economic backgrounds.³

Second, studies have found that psychological comorbidities in IBD patients are associated with opioid use. They may have increased pain due to psychological problems that require opioids for pain relief, or long-term opioid use may exacerbate psychological problems by affecting the chemical balance in the brain, creating a vicious cycle. This suggests that addressing psychological factors in routine IBD care will be critical in the future. Therefore, we need to pay close attention to the mental health of people with IBD and take timely psychotherapy when there are problems. At the same time, patients should be encouraged to take the initiative to contact and actively adapt to the social environment, adjust themselves, improve their coping skills, and reduce psychological problems such as depression or anxiety, which can effectively improve the level of disease self-management behaviors.⁴ Healthcare professionals should pay attention to improving the self-efficacy of IBD patients, enhance their confidence in facing the disease through timely encouragement, information support, and peer communication, and encourage family members to participate in the health management of the disease, so as to increase the social support of patients.

Third, pain management issues in patients with IBD were mentioned in the study as affecting quality of life, especially given the limited availability of alternative analgesics for pain control in these patients. Therefore, prescribing opioids for patients with IBD cannot be eliminated at this time. However, we agree that for patients with IBD, treatment can focus on controlling inflammation and improving bowel function to reduce pain and inflammation, thereby reducing the need for opioids. Also, prescribing weak opioid preparations reduces side effects and decreases patient dependence.⁵

In conclusion, opioid use can have many adverse effects on people with IBD, and there is also a complex relationship with psychological comorbidity. Therefore, reducing opioid use is critical to the long-term health and prognosis of patients with the condition.

Author Contributions

Y.Z.: writing—original manuscript; T.Y.: writing—original manuscript; S.L.: guidance, review, and editing.

Funding

This study was supported by the Minsheng Science and Technology Special Project I Social Development Topic (2021-004-SF0-0079).

Conflicts of Interest

These authors declare that there exists no potential conflict of interest.

Ethical Statement

The authors confirm that the approval of an institutional review board was not required for this work. The authors confirm that informed patient consent was not required for this work. We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.

References

Author notes