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The narcotic bowel syndrome: a recent update
Douglas Drossman1, Eva Szigethy2
1Department of Medicine and Psychiatry, University of North Carolina Center for Functional GI and Motility Disorders, and Drossman Gastroenterology PLLC, Chapel Hill, North Carolina, USA.
American Journal of Gastroenterology Supplements (Print)
|September 11, 2014
Summary
Narcotic bowel syndrome (NBS) causes chronic abdominal pain despite opioid use. Management involves opioid withdrawal and adjunctive therapies for improved function and quality of life.
Area of Science:
- Gastroenterology
- Pain Management
- Pharmacology
Background:
- Chronic opioid use can paradoxically cause worsening abdominal pain, a condition known as Narcotic Bowel Syndrome (NBS).
- NBS affects a small percentage of chronic opioid users, characterized by pain that escalates with increasing opioid doses.
Purpose of the Study:
- To review the understanding and management of Narcotic Bowel Syndrome.
- To differentiate NBS from peripheral opioid side effects and discuss its underlying mechanisms.
Main Methods:
- A literature search was performed using PubMed with keywords "narcotic bowel syndrome" and "opioid hyperalgesia" up to January 2014.
Main Results:
- NBS is defined by central nervous system dysfunction causing abdominal pain, distinct from peripheral opioid bowel dysfunction (e.g., constipation, bloating).
- Approximately 6% of chronic narcotic users develop NBS, significantly impairing daily function.
- Management focuses on structured opioid withdrawal combined with centrally acting medications (antidepressants, benzodiazepines, clonidine) and peripherally acting agents (laxatives).
Conclusions:
- Narcotic Bowel Syndrome rates are expected to increase, necessitating integrated pharmacotherapy and psychosocial interventions.
- Comprehensive treatment aims to help patients discontinue opioids, manage comorbid conditions, and improve pain control and quality of life.
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