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The narcotic bowel syndrome: clinical features, pathophysiology, and management.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Grunkemeier, David M. S. Cassara, Joseph E. Dalton, Christine Boag Drossman, Douglas A. |
| Copyright Year | 2007 |
| Abstract | Narcotic bowel syndrome (NBS) is a subset of opioid bowel dysfunction that is characterized by chronic or frequently recurring abdominal pain that worsens with continued or escalating dosages of narcotics. This syndrome is underrecognized and may be becoming more prevalent. In the United States this may be the result of increases in using narcotics for chronic nonmalignant painful disorders, and the development of maladaptive therapeutic interactions around its use. NBS can occur in patients with no prior gastrointestinal disorder who receive high dosages of narcotics after surgery or acute painful problems, and among patients with functional gastrointestinal disorders or other chronic gastrointestinal diseases who are managed by physicians who are unaware of the hyperalgesic effects of chronic opioids. The evidence for the enhanced pain perception is based on the following: (1) activation of excitatory antianalgesic pathways within a bimodal opioid regulation system, (2) descending facilitation of pain at the rostral ventral medulla and pain facilitation via dynorphin and cholecystokinin activation, and (3) glial cell activation that produces morphine tolerance and enhances opioid-induced pain. Treatment involves early recognition of the syndrome, an effective physician-patient relationship, graded withdrawal of the narcotic according to a specified withdrawal program, and the institution of medications to reduce withdrawal effects. |
| Starting Page | 776 |
| Ending Page | 779 |
| Page Count | 4 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://www.carolinashealthcare.org/documents/NorthEastInternalIntegrative/research-library/PostoperativeIleus/NarcoticBowelSyndrome.pdf |
| PubMed reference number | 17916540v1 |
| Volume Number | 5 |
| Issue Number | 10 |
| Journal | Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Abdominal Pain Acute inflammatory demyelinating polyneuropathy Blood Coagulation Disorders Dosage Dynorphins Functional Gastrointestinal Disorders Gastrointestinal Diseases Intestinal Diseases Intestines Irritable Bowel Syndrome Lambert-Eaton Myasthenic Syndrome Morphine Narcotics Neuroglia Opioids Pain Perception Patients facilitation |
| Content Type | Text |
| Resource Type | Article |
