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With a cautious approach including slow dose up\u2010titration and careful monitoring, effective analgesia can be achieved in most cirrhotic patients without significant side effects or decompensation of their liver disease. Paracetamol is safe in patients with chronic liver disease but reduced doses of 2\u20133 grams daily is recommended for long\u2010term use. Non\u2010steroidal anti\u2010inflammatory drugs are best avoided because of risk of renal impairment, hepatorenal syndrome, and gastrointestinal hemorrhage. Opioids have an increased risk of toxicity particularly in patients with hypoalbuminaemia, and immediate\u2010release as opposed to controlled\u2010release formulations are advised. Co\u2010prescription of laxatives is mandatory to avoid constipation and encephalopathy. Adjuvant analgesics such as tricyclic antidepressants and anti\u2010convulsants may be used cautiously for cirrhotic patients with neuropathic pain. Gabapentin or pregabalin may be better tolerated in cirrhosis because of non\u2010hepatic metabolism and a lack of anti\u2010cholinergic side effects.<\/jats:p>","DOI":"10.1111\/jgh.12560","type":"journal-article","created":{"date-parts":[[2014,2,19]],"date-time":"2014-02-19T02:58:44Z","timestamp":1392778724000},"page":"1356-1360","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["Analgesia for the cirrhotic patient: A literature review and recommendations"],"prefix":"10.1111","volume":"29","author":[{"given":"Jeremy P","family":"Dwyer","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chatura","family":"Jayasekera","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Nicoll","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,7,15]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.4065\/mcp.2009.0534"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.2165\/11635500-000000000-00000"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-008-0553-z"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200544020-00004"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840140650"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840210121"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clpt.2006.05.006"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840130428"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(95)90695-9"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01340406"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1994.00420020117013"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840040313"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2001.22172"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1983.14"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mjt.0000140216.40700.95"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20948"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c6764"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2009.04.015"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2007.03368.x"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-5-13"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v18.i24.3035"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(93)91024-C"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00542162"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.44.2.270"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2008.149"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20595"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365520310008205"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1990.203"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1990.tb03638.x"},{"key":"e_1_2_7_31_1","first-page":"83","article-title":"Pharmacokinetics of oral immediate\u2010release hydromorphone (Dilaudid IR) in subjects with moderate hepatic impairment","volume":"44","author":"Durnin C","year":"2001","journal-title":"Proc. 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