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Opioid misuse in gastroenterology and non-opioid management of abdominal pain
Open accessAbstract
Opioids were one of the earliest classes of medications used for pain across a variety of conditions, but morbidity and mortality have been increasingly associated with their chronic use. Despite these negative consequences, chronic opioid use is increasing worldwide, with the USA and Canada having the highest rates. Chronic opioid use for noncancer pain can have particularly negative effects in the gastrointestinal and central nervous systems, including opioid-induced constipation, narcotic bowel syndrome, worsening psychopathology and addiction. This Review summarizes the evidence of opioid misuse in gastroenterology, including the lack of evidence of a benefit from these drugs, as well as the risk of harm and negative consequences of opioid use relative to the brain-gut axis. Guidelines for opioid management and alternative pharmacological and nonpharmacological strategies for pain management in patients with gastrointestinal disorders are also discussed. As chronic pain is complex and involves emotional and social factors, a multimodal approach targeting both pain intensity and quality of life is best.
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“the development of narcotic bowel syndrome, an opioid induced paradoxical hyperalgesia. 26”
From Rome IV Functional Gastrointestinal Disorders and Health Impairment in Subjects With Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome (2021) · cites this paper as [26]
In the citing paper
“This would fit with ample evidence linking opioids to compounding and deleterious gastrointestinalrelated adverse effects, collectively known as opioid -induced bowel dysfunction. 26”
From Rome IV Functional Gastrointestinal Disorders and Health Impairment in Subjects With Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome (2021) · cites this paper as [26]
In the citing paper
“Among the most common symptoms of opioid-induced bowel dysfunction are abdominal pain, nausea, reflux, vomiting, and constipation”
From Rome IV Functional Gastrointestinal Disorders and Health Impairment in Subjects With Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome (2021) · cites this paper as [26]
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“However, there are limited nonpharmacological pain management treatments tailored to and evaluated in pediatric IBD (6).”
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“We examined medical conditions that are associated with opioid use and OUD (30–32).”
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BackgroundInfluentialEditorial: opioids in inflammatory bowel disease—primum non nocere
van der Have, M., & Maljaars, J. (2021) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.16286 · Cited by 5
Opioid-induced constipation in internal medicine: recognition and management pathways
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“conventional opioid agonists are the mainstay of the treatment in patients with severe acute and cancer‐related pain, the efficacy of opioids is controversial in long‐term use for chronic nonmalignant pain such as neuropathic, musculoskeletal, or abdominal.(3,25) Opioid use among HPN‐dependent patients appears concern…”
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“Opioids are the most effective analgesics, but their broad unexpected effects can be serious and even lethal (Szigethy et al., 2018).”
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Background
Metadata
- Authors
- Szigethy, E., Knisely, M., & Drossman, D.
- Affiliations
- University of Pittsburgh (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Szigethy, Eva
- Venue
- Nature Reviews Gastroenterology & Hepatology
- Published
- 2017-11-15
- Volume
- 15
- Issue
- 3
- Pages
- 168-180
- ISSN
- 1759-5045 (ISSN-L)
- 1759-5053
- PMC
- PMC6421506
- OpenAlex
- W2768878405
- Cited by
- 117
- References
- 202
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 10 · 2023: 14 · 2022: 15 · 2021: 23 · 2020: 17 · 2019: 15 · 2018: 7 · 2017: 1
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Gastroenterology & Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Psychiatric Publishing
- American Academy of Child and Adolescent Psychiatry
- Shionogi
- National Institutes of Health
- National Institute of Nursing Research (T32NR009759)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Keywords
- opioid misuse, chronic opioid use, abdominal pain, gastrointestinal diseases, opioid-induced constipation, narcotic bowel syndrome, opioid use disorder, gut-brain axis, non-pharmacological pain management, multimodal pain management, chronic non-cancer pain
- MeSH terms
- Analgesics, Analgesics, Opioid, Gastroenterology, Humans, Abdominal Pain, Inappropriate Prescribing, Pain Management
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