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Narcotic Bowel Syndrome and Opioid-Induced Constipation

  • Large Intestine (B Cash, Section Editor)
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Abstract

Prescription opioid use for chronic non-cancer pain has reached epidemic levels in the USA. With this increased use is the recognition of serious opioid-related gastrointestinal complications such as narcotic bowel syndrome (NBS) and opioid-induced constipation (OIC). NBS consists of a paradoxical worsening of abdominal pain with escalating doses of opioids and is likely mediated by the central nervous system. Therapy requires an intensive multidisciplinary approach to detoxification. OIC is the most common gastrointestinal side effect of opioids. Several novel therapeutics are available to treat OIC that fails to respond to laxative therapy. This review will summarize recent findings on the pathophysiology and treatment approaches to NBS and OIC with a focus on controversies about diagnosis and intervention.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85–92.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mehendale AW, Goldman MP, Mehendale RP. Opioid overuse pain syndrome (OOPS): the story of opioids, prometheus unbound. J Opioid Manag. 2013;9(6):421–38.

    Article  PubMed  Google Scholar 

  3. Manchikanti L, Helm 2nd S, Fellows B, et al. Opioid epidemic in the United States. Pain Phys. 2012;15(3 Suppl):Es9–Es38.

    Google Scholar 

  4. Berry PH, Dahl JH. Making pain assessment and management a healthcare system priority through the new JCAHO pain standards. J Pharm Care Pain Symptom Control. 2000;8:5–20.

    Article  Google Scholar 

  5. Grunkemeier DM, Cassara JE, Dalton CB, Drossman DA. The narcotic bowel syndrome: clinical features, pathophysiology, and management. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2007;5(10):1126–39. quiz 1121–1122. The first comprehensive review of the characteristics, etiology and treatment of narcotic bowel syndrome.

    CAS  Google Scholar 

  6. Grover M, Drossman DA. Psychopharmacologic and behavioral treatments for functional gastrointestinal disorders. Gastrointest Endosc Clin N Am. 2009;19(1):151–70. vii-viii.

    Article  PubMed  Google Scholar 

  7. Drossman DA, Morris CB, Edwards H, et al. Diagnosis, characterization, and 3-month outcome after detoxification of 39 patients with narcotic bowel syndrome. Am J Gastroenterol. 2012;107(9):1426–40. The first study showing that hospital-based detoxification of patients with narcotic bowel syndrome resulted in reduced pain. Approximately half of the patients reverted to opioid use at 3 months illustrating the need for more intensive post-hospitalization follow-up but the patients who stayed off narcotics showed a greater improvement in pain scores.

    Article  PubMed  CAS  Google Scholar 

  8. Tuteja AK, Biskupiak J, Stoddard GJ, Lipman AG. Opioid-induced bowel disorders and narcotic bowel syndrome in patients with chronic non-cancer pain. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2010;22(4):424–30. e496.

    Article  CAS  Google Scholar 

  9. Choung RS, Locke 3rd GR, Zinsmeister AR, Schleck CD, Talley NJ. Opioid bowel dysfunction and narcotic bowel syndrome: a population-based study. Am J Gastroenterol. 2009;104(5):1199–204.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. O’Lenic KS. When should narcotic bowel syndrome be suspected? US Pharm. 2011;36:41–4.

    Google Scholar 

  11. Association AP. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Google Scholar 

  12. Miller AR, North CS, Clouse RE, Wetzel RD, Spitznagel EL, Alpers DH. The association of irritable bowel syndrome and somatization disorder. Ann Clin Psychiatr Off J Am Acad Clin Psychiatr. 2001;13(1):25–30.

    Article  CAS  Google Scholar 

  13. North CS, Downs D, Clouse RE, et al. The presentation of irritable bowel syndrome in the context of somatization disorder. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2004;2(9):787–95.

    Google Scholar 

  14. Phillips K, Clauw DJ. Central pain mechanisms in chronic pain states—maybe it is all in their head. Best Pract Res Clin Rheumatol. 2011;25(2):141–54.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Drossman DA, Szigethy E. Narcotic bowel syndrome: 2014 update. Am J Gastroenterol. 2014;in press.

  16. Johnston IN, Milligan ED, Wieseler-Frank J, et al. A role for proinflammatory cytokines and fractalkine in analgesia, tolerance, and subsequent pain facilitation induced by chronic intrathecal morphine. J Neurosci Off J Soc Neurosci. 2004;24(33):7353–65.

    Article  CAS  Google Scholar 

  17. Hutchinson MR, Bland ST, Johnson KW, Rice KC, Maier SF, Watkins LR. Opioid-induced glial activation: mechanisms of activation and implications for opioid analgesia, dependence, and reward. Sci World J. 2007;7:98–111. Innovative review showing the mechanisms by which central glial cell activation resulting in the release of pro-inflammatory cytokines is involved in opioid-induced pain. The role of glial modulators to treat neuropathic pain is also discussed.

    Article  Google Scholar 

  18. Farmer AD, Ferdinand E, Aziz Q. Opioids and the gastrointestinal tract—a case of narcotic bowel syndrome and literature review. J Neurogastroenterol Motil. 2013;19(1):94–8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. King T, Ossipov MH, Vanderah TW, Porreca F, Lai J. Is paradoxical pain induced by sustained opioid exposure an underlying mechanism of opioid antinociceptive tolerance? Neuro-Signals. 2005;14(4):194–205.

    Article  PubMed  CAS  Google Scholar 

  20. Kaplan H, Fields HL. Hyperalgesia during acute opioid abstinence: evidence for a nociceptive facilitating function of the rostral ventromedial medulla. J Neurosci Off J Soc Neurosci. 1991;11(5):1433–9.

    CAS  Google Scholar 

  21. Burgess SE, Gardell LR, Ossipov MH, et al. Time-dependent descending facilitation from the rostral ventromedial medulla maintains, but does not initiate, neuropathic pain. J Neurosci Off J Soc Neurosci. 2002;22(12):5129–36.

    CAS  Google Scholar 

  22. Hutchinson MR, Northcutt AL, Hiranita T, et al. Opioid activation of toll-like receptor 4 contributes to drug reinforcement. J Neurosci Off J Soc Neurosci. 2012;32(33):11187–200.

    Article  CAS  Google Scholar 

  23. Hutchinson MR, Watkins LR. Why is neuroimmunopharmacology crucial for the future of addiction research? Neuropharmacology. 2014;76 Pt B:218–27.

    Article  PubMed  Google Scholar 

  24. Fujio M, Nakagawa T, Sekiya Y, et al. Gene transfer of GLT-1, a glutamate transporter, into the nucleus accumbens shell attenuates methamphetamine- and morphine-induced conditioned place preference in rats. Eur J Neurosci. 2005;22(11):2744–54.

    Article  PubMed  Google Scholar 

  25. Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Phys. 2011;14(2):145–61.

    Google Scholar 

  26. Lee YS, Muthu D, Hall SM, et al. Discovery of amphipathic dynorphin a analogues to inhibit the neuroexcitatory effects of dynorphin a through bradykinin receptors in the spinal cord. J Am Chem Soc. 2014;136(18):6608–16.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Xie JY, Herman DS, Stiller CO, et al. Cholecystokinin in the rostral ventromedial medulla mediates opioid-induced hyperalgesia and antinociceptive tolerance. J Neurosci Off J Soc Neurosci. 2005;25(2):409–16.

    Article  Google Scholar 

  28. Wagner KM, Roeder Z, Desrochers K, Buhler AV, Heinricher MM, Cleary DR. The dorsomedial hypothalamus mediates stress-induced hyperalgesia and is the source of the pronociceptive peptide cholecystokinin in the rostral ventromedial medulla. Neuroscience. 2013;238:29–38.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  29. Kurlander JE, Drossman DA. Diagnosis and treatment of narcotic bowel syndrome. Nat Rev Gastroenterol Hepatol. 2014.

  30. Lobmaier P, Gossop M, Waal H, Bramness J. The pharmacological treatment of opioid addiction—a clinical perspective. Eur J Clin Pharmacol. 2010;66(6):537–45.

    Article  PubMed  CAS  Google Scholar 

  31. Liu KS, Chen SJ, Chen YW, Sung KC, Wang JJ. A dose-response study on the efficacy of tricyclic antidepressants on reducing morphine-withdrawal symptoms. Acta Anaesthesiol Taiwan Off J Taiwan Soc Anesthesiol. 2013;51(1):18–21.

    Article  Google Scholar 

  32. Rahimi R, Nikfar S, Rezaie A, Abdollahi M. Efficacy of tricyclic antidepressants in irritable bowel syndrome: a meta-analysis. World J Gastroenterol WJG. 2009;15(13):1548–53.

    Article  CAS  Google Scholar 

  33. Hutchinson MR, Loram LC, Zhang Y, et al. Evidence that tricyclic small molecules may possess toll-like receptor and myeloid differentiation protein 2 activity. Neuroscience. 2010;168(2):551–63. A study in mice showing that tricyclic antidepressants selectively modulate Toll-like receptors involved in the pain and may enhance the analgesic efficacy of opioids.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  34. Bellingham GA, Peng PW. Duloxetine: a review of its pharmacology and use in chronic pain management. Reg Anesth Pain Med. 2010;35(3):294–303.

    Article  PubMed  CAS  Google Scholar 

  35. Onal A, Parlar A, Ulker S. Milnacipran attenuates hyperalgesia and potentiates antihyperalgesic effect of tramadol in rats with mononeuropathic pain. Pharmacol Biochem Behav. 2007;88(2):171–8.

    Article  PubMed  Google Scholar 

  36. Wu N, Chen SY, Hallett LA, et al. Opioid utilization and health-care costs among patients with diabetic peripheral neuropathic pain treated with duloxetine vs. other therapies. Pain Pract Off J World Inst Pain. 2011;11(1):48–56.

    Article  CAS  Google Scholar 

  37. Andrews JS, Wu N, Chen SY, Yu X, Peng X, Novick D. Real-world treatment patterns and opioid use in chronic low back pain patients initiating duloxetine versus standard of care. J Pain Res. 2013;6:825–35.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Dworkin RH, Corbin AE, Young Jr JP, et al. Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology. 2003;60(8):1274–83.

    Article  PubMed  CAS  Google Scholar 

  39. Lee KJ, Kim JH, Cho SW. Gabapentin reduces rectal mechanosensitivity and increases rectal compliance in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2005;22(10):981–8.

    Article  PubMed  CAS  Google Scholar 

  40. Arnold LM, Crofford LJ, Martin SA, Young JP, Sharma U. The effect of anxiety and depression on improvements in pain in a randomized, controlled trial of pregabalin for treatment of fibromyalgia. Pain Med (Malden, Mass). 2007;8(8):633–8.

    Article  Google Scholar 

  41. Arnold LM, Russell IJ, Diri EW, et al. A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia. J Pain Off J Am Pain Soc. 2008;9(9):792–805.

    Article  CAS  Google Scholar 

  42. Narita N, Kumar N, Cherkas PS, et al. Systemic pregabalin attenuates sensorimotor responses and medullary glutamate release in inflammatory tooth pain model. Neuroscience. 2012;218:359–66.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  43. Harris RE, Napadow V, Huggins JP, et al. Pregabalin rectifies aberrant brain chemistry, connectivity, and functional response in chronic pain patients. Anesthesiology. 2013;119(6):1453–64.

    Article  PubMed  CAS  Google Scholar 

  44. Hackworth RJ, Tokarz KA, Fowler IM, Wallace SC, Stedje-Larsen ET. Profound pain reduction after induction of memantine treatment in two patients with severe phantom limb pain. Anesth Analg. 2008;107(4):1377–9.

    Article  PubMed  Google Scholar 

  45. Grande LA, O’Donnell BR, Fitzgibbon DR, Terman GW. Ultra-low dose ketamine and memantine treatment for pain in an opioid-tolerant oncology patient. Anesth Analg. 2008;107(4):1380–3.

    Article  PubMed  Google Scholar 

  46. Phillips K, Clauw DJ. Central pain mechanisms in the rheumatic diseases: future directions. Arthritis Rheum. 2013;65(2):291–302.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Palsson OS, Whitehead WE. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2013;11(3):208–16. quiz e222-203.

    Google Scholar 

  48. Szigethy E, Bujoreanu SI, Youk A, et al. Randomized efficacy trial of two psychotherapies for depression in youth with inflammatory bowel disease. J Am Acad Child Adolesc. 2014;in press.

  49. Mawdsley JE, Jenkins DG, Macey MG, Langmead L, Rampton DS. The effect of hypnosis on systemic and rectal mucosal measures of inflammation in ulcerative colitis. Am J Gastroenterol. 2008;103(6):1460–9.

    Article  PubMed  Google Scholar 

  50. Schoen M, Nowack K. Reconditioning the stress response with hypnosis CD reduces the inflammatory cytokine IL-6 and influences resilience: a pilot study. Complement Ther Clin Pract. 2013;19(2):83–8.

    Article  PubMed  Google Scholar 

  51. Camilleri M, Drossman DA, Becker G, Webster LR, Davies AN, Mawe GM. Unmet needs in opioid induced constipation. Neurogastroenter Motil, 2014, in press.

  52. Dunn KM, Saunders KW, Rutter CM, et al. Opioid precriptions for chronic pain and overdose: a cohort study. Ann Int Med. 2010;152(2):85–92.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kalso E, Edwards JE, Moore, et al. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain. 2004;112(3):372–80.

    Article  PubMed  CAS  Google Scholar 

  54. Benyamin R, Trescot AM, Datta S, et al. Opiod complications and side effects. Pain Phys. 2008;11(2 Suppl):S105–20.

    Google Scholar 

  55. Camilleri M. Opioid-induced constipation: challenges and therapeutic opportunities. Am J Gastro. 2011;106(5):835–42.

    Article  CAS  Google Scholar 

  56. Holzer P. Opioids and opioid receptors in the enteric nervous system: from a problem in opioid analgesia to a possible new prokinetic therapy in humans. Neurosci Lett. 2004;361(1–3):192–5.

    Article  PubMed  CAS  Google Scholar 

  57. Ishihara M, Ikesue H, Matsunaga H, et al. A multi-institutional study analyzing effect of prophylactic medication for prevention of opioid-induced gastrointestinal dysfunction. Clin J Pain. 2012;28(5):373–81. A large retrospective study in patients with cancer pain. The study showed that prophylactic use of osmotic laxatives decreased constipation by almost half, although early antiemetic use did not decrease nausea.

    Article  PubMed  Google Scholar 

  58. Myotoku M, Nakanashi A, Kanematsu M, et al. Reduction of opioid side effects by prophylactic measures of palliative care team may result in improved quality of life. J Palliat Med. 2010;13(4):401–6.

    Article  PubMed  Google Scholar 

  59. Dipalma JA, Cleveland MV, McGowan J, Herrera JL. A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. Am J Gastroenterol. 2007;102(7):1436–41.

    Article  PubMed  CAS  Google Scholar 

  60. Johanson JF, Morton D, Geenen J, Ueno R. Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of lubiprostone, a locally-acting type-2 chloride channel activator, in patients with chronic constipation. Am J Gastroenterol. 2008;103(1):170–7.

    Article  PubMed  CAS  Google Scholar 

  61. Drossman DA, Chey WD, Johanson JF, Fass R, Scott C, Panas R, et al. Clinical trial: lubiprostone in patients with constipation-associated irritable bowel syndrome—results of two randomized, placebo-controlled studies. Aliment Pharmacol Ther. 2009;29(3):329–41.

    Article  PubMed  CAS  Google Scholar 

  62. Cryer B, Katz S, Vallejo R, Popescu A, Ueno R. A randomized study of lubiprostone for opioid-induced constipation in patients with chronic noncancer pain. Pain Med. 2014 Apr 9. [Epub ahead of print]

  63. Irving G, Penzes J, Ramjattan B, et al. A randomized, placebo-controlled phase 3 trial (study SB-767905/013) of alvimopan for opioid-induced bowel dysfunction in patients with non-cancer pain. J Pain. 2011;12(2):175–84.

    Article  PubMed  CAS  Google Scholar 

  64. Jansen J-P, Lorch D, Langan, et al. A randomized, placebo-controlled phase 3 trial (Study SB-767905/012) of alvimopan for opioid-induced bowel dysfunction in patients with non-cancer pain. The Journal of Pain. 2011;12(2):185–93.

    Article  PubMed  CAS  Google Scholar 

  65. Ford AC, Brenner DM, Schoenfeld PS. Efficacy of pharmacological therapies for the treatment of opioid-induced constipation: systematic review and meta-analysis. Am J Gastroenterol. 2013;108(10):1566–74. An up to date meta-analysis of the clinical trials data on methylnaltrexone, alvimopan, and oxycodone/naloxone. A systematic review of other medical therapies is included.

    Article  PubMed  CAS  Google Scholar 

  66. Michna E, Blonsky ER, Schulman S, et al. Subcutaneous methylnaltrexone for treatment of opioid-induced constipation in patients with chronic, nonmalignant pain: a randomized controlled study. J Pain. 2011;12(5):554–62.

    Article  PubMed  CAS  Google Scholar 

  67. Rauck RL, Peppin JP, Israel RJ, et al. Oral methylnaltrexone for the treatment of opioid-induced constipation in patients with noncancer pain. Gastroenterology. 2012;142(5, Supp1):S160.

    Google Scholar 

  68. Hartrick C, Van Hove I, Stegmann J-U, Oh C, Upmalis D. Efficacy and tolerability of tapentadol immediate release and oxycodone HCl immediate release in patients awaiting primary joint replacement surgery for end-stage joint disease: a 10-day, phase III, randomized, double-blind, active- and placebo-controlled study. Clin Ther. 2009;31(2):260–71.

    Article  PubMed  CAS  Google Scholar 

  69. Gálvez R, Schäfer M, Hans G, Falke D, Steigerwald I. Tapentadol prolonged release versus strong opioids for severe, chronic low back pain: results of an open-label, phase 3b study. Adv Ther. 2013;30(3):229–59.

    Article  PubMed  Google Scholar 

  70. Etropolski M, Kelly K, Okamoto A, Rauschkolb C. Comparable efficacy and superior gastrointestinal tolerability (nausea, vomiting, constipation) of tapentadol compared with oxycodone hydrochloride. Adv Ther. 2011;28(5):401–17.

    Article  PubMed  CAS  Google Scholar 

  71. Lowenstein O, Leyendecker P, Hopp M, et al. Combined prolonged-release oxycodone and naloxone improves bowel function in patients receiving opioids for moderate-to-severe non-malignant chronic pain: a randomised controlled trial. Expert Opin Pharmacother. 2009;10(4):531–43.

    Article  PubMed  CAS  Google Scholar 

  72. Meissner W, Leyendecker P, Mueller-Lissner S, et al. A randomised controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. Eur J Pain. 2009;13(1):56–64.

    Article  PubMed  CAS  Google Scholar 

  73. Simpson K, Leyendecker P, Hopp M, et al. Fixed-ratio combination oxycodone/naloxone compared with oxycodone alone for the relief of opioid-induced constipation in moderate-to-severe noncancer pain. Curr Med Res Opin. 2008;24(12):3503–12.

    Article  PubMed  CAS  Google Scholar 

  74. Chey WD, Webster L, Sostek M, Lappalainen J, Barker PN, Tack J. Naloxegol for opioid-induced constipation in patients with noncancer pain. N Engl J Med. 2014 Jun 4. [Epub ahead of print]

  75. Camilleri M, Kerstens R, Rykx A, Vandeplassche L. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med. 2008;358(22):2344–54.

    Article  PubMed  CAS  Google Scholar 

  76. Bouras EP, Camilleri M, Burton DD, Thomforde G, McKinzie S, Zinsmeister AR. Prucalopride accelerates gastrointestinal and colonic transit in patients with constipation without a rectal evacuation disorder. Gastroenterology. 2001;120(2):354–60.

    Article  PubMed  CAS  Google Scholar 

  77. Sloots CE, Rykx A, Cools M, Kerstens R, De Pauw M. Efficacy and safety of prucalopride in patients with chronic noncancer pain suffering from opioid-induced constipation. Dig Dis Sci. 2010;55(10):2912–21.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  78. Ketwaroo GA, Cheng V, Lembo A. Opioid-induced bowel dysfunction. Curr Gastroenterol Rep. 2013;15(9):344–50.

    Article  PubMed  Google Scholar 

  79. Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers—United States, 1999--2008. MMWR Morb Mortal Wkly Rep. 2011;60(43):1487–92. Governmental report quantifies the marked increase in US opioid prescribing over the past decade and the resulting toll of morbidity and mortality.

    Google Scholar 

  80. Deshpande A, Furlan A, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database Syst Rev. 2007;3, CD004959.

    PubMed  Google Scholar 

  81. Franklin GM, Rahman EA, Turner JA, Daniell WE, Fulton-Kehoe D. Opioid use for chronic low back pain: a prospective, population-based study among injured workers in Washington state, 2002–2005. Clin J Pain. 2009;25(9):743–51.

    Article  PubMed  Google Scholar 

  82. Franklin GM, Stover BD, Turner, et al. Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort. Spine. 2008;33(2):199–204.

    Article  PubMed  Google Scholar 

  83. Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infection and mortality in patients with Crohn’s disease: more than 5 years of follow-up in the TREAT™ registry. Am J Gastroenterol. 2012;107(9):1409–22.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  84. Kobus AM, Smith DH, Morasco BJ, Johnson ES, Yang X, Petrik AF, et al. Correlates of higher-dose opioid medication use for low back pain in primary care. J Pain. 2012;13(11):1131–8.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Chou R, Shekelle P. Will this patient develop disabling low back pain? JAMA. 2010;303(13):1295–1302.87.

    Article  PubMed  CAS  Google Scholar 

  86. Fleming MF, Balousek SL, Klessig CL, Mundt MP, Brown DD. Substance use disorders in a primary care sample receiving daily opioid therapy. J Pain. 2007;8(7):573–82.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  87. Hill JC, Whitehurst DG, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011;378(9802):1560–71.

    Article  PubMed  PubMed Central  Google Scholar 

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Conflict of Interest

Dr. Drossman is a consultant for AstraZeneca, Furiex Pharmaceuticals, Ironwood Pharmaceuticals, and Takeda and is on an Advisory Board for Synergy Pharmaceuticals. Dr. Szigethy was on an Advisory Board for Merck Pharmaceuticals and receives research funding from NIMH, NIH, and Crohn’s and Colitis Foundation of America. Dr. Schwartz has no conflicts to declare.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Psychiatry, University of Pittsburgh, Medical Arts Building, 3708 Fifth Ave, Pittsburgh, PA, 15213, USA

    Eva Szigethy

  2. Department of Medicine, University of Pittsburgh, Medical Arts Building, 3708 Fifth Ave, Pittsburgh, PA, 15213, USA

    Eva Szigethy

  3. Department of Pediatrics, University of Pittsburgh, Medical Arts Building, 3708 Fifth Ave, Pittsburgh, PA, 15213, USA

    Eva Szigethy

  4. Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Medical Arts Building, 3708 Fifth Ave, Pittsburgh, PA, 15213, USA

    Marc Schwartz

  5. Center for Education and Practice of Biopsychosocial Care LLC, Chapel Hill, NC, USA

    Douglas Drossman

  6. Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA

    Douglas Drossman

  7. Drossman Gastroenterology PLLC, Chapel Hill, NC, USA

    Douglas Drossman

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  1. Eva Szigethy
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  2. Marc Schwartz
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Correspondence to Eva Szigethy.

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Szigethy, E., Schwartz, M. & Drossman, D. Narcotic Bowel Syndrome and Opioid-Induced Constipation. Curr Gastroenterol Rep 16, 410 (2014). https://doi.org/10.1007/s11894-014-0410-4

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