Major Finding: Of patients with irritable bowel syndrome, 18% were using narcotic pain medications to relieve bowel pain.
Data Source: An internet survey of 1,787 patients with irritable bowel syndrome.
Disclosures: The University of North Carolina and the International Foundation for Functional GI and Motility Disorders sponsored the study. Dr. Dorn had no relevant financial disclosures.
NEW ORLEANS — Many patients with irritable bowel syndrome appear to be taking narcotics for bowel pain—drugs that may exacerbate their painful symptoms.
A survey of nearly 2,000 patients with irritable bowel syndrome (IBS) found that nearly 20% were currently taking a narcotic for their symptoms. “Narcotic use of that magnitude in this population has not been previously described,” Dr. Spencer Dorn said at the meeting.
Patients who took narcotics were more likely to report poor health-related quality of life, to also use antidepressants and anxiolytic drugs, and to have more hospitalizations and surgeries than IBS patients who don't use narcotics.
“In the current U.S. health care system, clinicians often lack the time, infrastructure, and incentive needed to provide integrative care to patients with chronic conditions, including IBS,” said Dr. Dorn. “Instead, very often physicians take the path of least resistance. Narcotic prescriptions are a quick and easy way to get patients out of the office,” even though the long-term effects can be harmful.
“The broad literature suggests that narcotic use in noncancer pain syndromes may not improve functional status and help people live their lives more effectively,” he said. “It is also very well known that narcotics affect bowel habits; narcotic-induced constipation is very common.”
Additionally, he said, narcotics always carry a risk of drug dependence, leading to the need for increasing amounts of medication. “Narcotic bowel syndrome is gaining recognition” as a consequence of long-term narcotic use, he said. “Even though we are using narcotics to treat pain, escalating the dose may paradoxically worsen the symptoms we are trying to treat.”
Dr. Dorn, of the Center for Functional GI and Motility Disorders at the University of North Carolina, Chapel Hill, and his colleagues at the International Foundation for Functional Gastrointestinal Disorders in Milwaukee, conducted an Internet survey of 1,787 adults in the United States and Canada who fit the Rome II criteria for IBS diagnosis. Results of this survey were initially published last year (J. Clin. Gastroenterol. 2009;43:541-50) and used as the basis for an informational brochure (www.aboutibs.org/pdfs/IBSpatients.pdf
Respondents were mostly women (83%) and white (91%). IBS types were 29% diarrhea predominant, 61% mixed diarrhea/constipation/unspecified, and 10% constipation predominant. As determined by the Functional Bowel Disorder Severity Index, 31% had mild symptoms, 48% had moderate symptoms, and 21% had severe symptoms. Diagnosis of IBS was not made until a mean of almost 7 years after their symptoms began.
Most of the respondents (80%) said that pain was a major contributing factor to the severity of their IBS, with 30% saying it was the most troublesome symptom, and 78% saying their pain was continuous or frequent in the prior 6 months.
Most of the respondents were taking at least one medication, including nonnarcotic pain medications (31%), antidepressants for pain (31%), antacids (28%), antidiarrheals (24%), antispasmodics (19%), and narcotics (18%).
A regression analysis found that narcotic use was significantly associated with low health-related quality of life; rating pain as the most bothersome symptom; having a larger number of hospitalizations and surgeries; and the concurrent use of antidepressants, anxiolytics, and antacid medications.
The preferred approach to IBS treatment is a holistic one, Dr. Dorn said.
“We suggest an integrated approach in which clinicians first consider the medical and psychosocial factors that influence their patients' illness, and then address their patients' main concerns, educate them about IBS, offer strategies to enhance their self-management, and, if appropriate, address any maladaptive coping styles and the possible role of psychological stressors. This approach is often best delivered by a multidisciplinary treatment team.”
'Narcotic bowel syndrome is gaining recognition' as a consequence of long-term narcotic use.
Source DR. DORN