ReviewAmerican journal of gastroenterology supplements (Print)2014
The narcotic bowel syndrome: a recent update.
Review in American journal of gastroenterology supplements (Print), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 79 citations in OpenAlex.
- Cardiovascular phenotyping for personalized lifestyle treatments of chronic abdominal pain in Irritable Bowel Syndrome: A randomized pilot study.Neurogastroenterology and motility · 2019Trial
- Surgical management of chronic pancreatitis: A narrative review.United European gastroenterology journal · 2025Review
- Neuropancreatology: The Nervous System and Pain Management in Pancreatic Diseases.Life (Basel, Switzerland) · 2024Review
- The interplay between the microbiota and opioid in the treatment of neuropathic pain.Frontiers in microbiology · 2024Review
- A Missing Piece of the Puzzle: Patient and Provider Perspectives on Pain Management Needs and Opioid Prescribing in Inflammatory Bowel Disease Care.Crohn's & colitis 360 · 2022Article
- Opioid-related emergency department visits and hospitalizations among patients with chronic gastrointestinal symptoms and disorders dually enrolled in the Department of Veterans Affairs and Medicare Part D.American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists · 2022Article
- Less Well-Known Consequences of the Long-Term Use of Opioid Analgesics: A Comprehensive Literature Review.Drug design, development and therapy · 2022Review
- High-Dose Opioid Use Among Veterans with Unexplained Gastrointestinal Symptoms Versus Structural Gastrointestinal Diagnoses.Digestive diseases and sciences · 2021Article
- Article
- Observational
- Review
- The impact of opioid use on human and health care costs in surgical patients.Surgery open science · 2020Article
- Diabetic Gastroparesis.Endocrine reviews · 2019Review
- Abdominal Pain in Patients with Gastroparesis: Associations with Gastroparesis Symptoms, Etiology of Gastroparesis, Gastric Emptying, Somatization, and Quality of Life.Digestive diseases and sciences · 2019Observational
- Implications of the Opioid Epidemic for the Clinical Gastroenterology Practice.Current gastroenterology reports · 2019Review
- Opioid misuse in gastroenterology and non-opioid management of abdominal pain.Nature reviews. Gastroenterology & hepatology · 2018Review
- Chronic opioids in gastroparesis: Relationship with gastrointestinal symptoms, healthcare utilization and employment.World journal of gastroenterology · 2017Observational
- Opioids in Gastroenterology: Treating Adverse Effects and Creating Therapeutic Benefits.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2017Review
- Opioid Medications in the Management of Chronic Abdominal Pain.Current pain and headache reports · 2017Review
- Predictors of Chronic Opioid Use in Newly Diagnosed Crohn's Disease.Inflammatory bowel diseases · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe paradoxical development of chronic abdominal pain is an underrecognized side effect of opioid use. Narcotic bowel syndrome (NBS), occurring in a small proportion of chronic opioid users, consists of chronic or intermittent abdominal pain, which often increases in severity despite continued or escalating dosages of opioids prescribed to relieve pain.
methodsA PubMed search was conducted using terms such as "narcotic bowel syndrome" and "opioid hyperalgesia" through January 2014.
resultsAbdominal pain is the defining symptom of NBS and is thought to be mediated by central nervous system dysfunction; it should be distinguished from the peripheral side effects of opioids, such as nausea, bloating, intermittent vomiting, abdominal distension, and constipation. This latter cluster of symptoms is called opioid bowel dysfunction, although it may co-occur with NBS. Hypothesized mechanisms of the central effects of opioids on nociception in NBS include spinal cord inflammation and dysfunction in opioid receptor activity and related neuroanatomical substrates. With continued use, ∼6% of patients taking narcotics chronically will develop NBS, with profound consequences in terms of daily function. The primary management paradigm for NBS is a structured opioid withdrawal program accompanied by centrally acting adjunctive therapy comprising antidepressants, benzodiazepines, and clonidine to target pain, anxiety, and depression, and prevent withdrawal effects, in addition to peripherally acting agents such as laxatives (e.g., osmotic laxatives and chloride channel activators) to control transient constipation. Such structured withdrawal programs have been prospectively evaluated in small clinical trials and have met with considerable success in the short term.
conclusionsBecause rates of NBS are likely to rise, integrated intensive pharmacotherapy and psychosocial interventions are needed to help patients with NBS go off and stay off opioids. These programs will likely also reduce comorbid psychopathology and lead to adequate pain control and improved quality of life.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.