Treatment

The UNC group has also developed a treatment approach. The narcotic is withdrawn and substituted with effective alternative medications to help manage the pain and the bowel symptoms until the narcotics are removed from the system. This requires the doctor and patient working closely together. The doctor must take time to explain the condition, the reasons for withdrawing the narcotics, and the alternative treatment plan. The treatment process usually takes a week or two in the hospital but may take several weeks or months outside the hospital to implement satisfactorily, with the doctor staying in touch with the patient during this period. 

The UNC group reported an outcome study on detoxification of 39 patients who had narcotic bowel syndrome.[3] Most (almost 90%) had clinically significant reduction in bowel and other bodily pains at the end of the detoxification. However about 46% of these patients were back on narcotics 3 months later. This latter finding highlights the importance of addressing this serious medical issue to the health care community and society in general. 

Narcotic bowel syndrome was first reported over 25 years ago, but it remains under-recognized. There is a general lack of knowledge among health care providers about long-term effects of narcotics to increase pain and motility disturbances. Plus, it is difficult to tell the difference between pain that results from narcotics and the pain that is being treated.

Narcotics have a role in medical care but there are times where the risks outweigh the benefits. If your doctor suggests a narcotic to treat pain from a functional GI disorder, be sure to ask about narcotic bowel syndrome. Mutual understanding of risk, as well as benefit, is an important part of any treatment.

References:

  1. Grunkemeier DM, et al. The narcotic bowel syndrome: clinical features, pathophysiology, and management. Clin Gastroenterol Hepatol. 2007 Oct;5(10):1126-39
  2. Keefer L, et al. Centrally mediated disorders of gastrointestinal pain. Gastroenterology. 2016; 150:1408–1419
  3. Drossman DA, et al. Diagnosis, characterization, and 3-month outcome after detoxification of 39 patients with narcotic bowel syndrome. Am J Gastroenterol. 2012 Sep;107(9):1426-40.

For healthcare providers: Here is a video of a presentation by Douglas A. Drossman delivered at the UCLA GI Week 2016 on the topic, "State of the Art Lecture: Understanding and Management of Patients with Chronic Abdominal Pain and Narcotic Bowel Syndrome." 

 

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