Opioids and the Gastrointestinal Tract - A Case of Narcotic Bowel Syndrome and Literature Review
Adam D Farmer, Ella Ferdinand and Qasim Aziz
J Neurogastroenterol Motil, Vol. 19 No. 1 January, 2013
The authors describe a familiar presentation of increasing GI symptoms and abdominal pain in the face of increasing doses of opiate medications, noting "Although it seems paradoxical, chronic opiate use may lead to a pro-nociceptive state."
In the process the coin a new diagnostic term (to me at least) Narcotic Bowel Syndrome "chronic or intermittent colicky abdominal pain or discomfort that worsens after the narcotic effects of opiates wear off."
This particular patient was a 26 yo woman with a 5 year history of abdominal pain, at the time of intervention she was on
150 μg/hr fentanyl, 100 mg oramorph and 400 mg tramadol (equivalent to approximately 740 mg oral morphine/24 hr). A clinical diagnosis of narcotic bowel syndrome (NBS) was made. A detoxification regimen was prescribed which included rapid opiate withdrawal and commencement of methadone, lorazepam, clonidine and duloxetine. She was discharged opiate free, with no abdominal pain, 14 days post admission. At outpatient review for 3 months after discharge, her abdominal pain has not returned and she remains well with no further hospital admissions.
