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narcotic bowel syndrome; opioid-induced gastrointestinal hyperalgesia

unexplained abdominal pain that is treated with opioids & persists or worsens while opioid doses are maintained or increased Etiology: - may associated with opioid-related dysmotility (i.e. constipation, gastroparesis, ileus) - idiopathic Pathology: - opiate-induced gastrointestinal hyperalgesia Clinical manifestations: - paradoxical increase in abdominal pain with increasing doses of narcotics Management: - discontinue opiates - may need to taper in a monitored environment - high rate of recidivism

Related

opioid-induced constipation (OIC)

General

syndrome intestinal disease opioid-induced hyperalgesia

References

  1. Drossman DA et al. Diagnosis, characterization, and 3-month outcome after detoxification of 39 patients with narcotic bowel syndrome. Am J Gastroenterol 2012 Sep; 107:1426.
  2. Keefer L, Drossman DA, Guthrie E Centrally Mediated Disorders of Gastrointestinal Pain. Gastroenterology. 2016 Feb 19. PMID: 27144628
  3. Medical Knowledge Self Assessment Program (MKSAP) 18, 19. American College of Physicians, Philadelphia 2018, 2021