Abstract
Purpose of Review
Chronic abdominal pain is a complex medical condition. The causes of chronic abdominal pain are extremely diverse ranging from chronic pancreatitis, Crohn’s disease, to chronic pain with no clear etiology. Treatment of chronic abdominal pain remains a challenge in our clinical practice. While current interventions with celiac plexus blocks and pain medications provide some relief for these patients, but these treatments are typically less efficacious and limited by various adverse effects. Opioid medications are commonly used to manage chronic pain syndromes that are refectory to other pain management interventions. The potential problems related to opioids include misuse, abuse, constipation, nausea pruritus, et al. Moreover, according to the recent centers for disease (CDC) control report, opioid abuse has reached epidemic proportions in the USA (LJ P. Centers for Disease Control and Prevention. 2016) and accounted for 28,000 deaths in 2014. Rudd et al. (MMWR Morb Mortal Wkly Rep 64(50–51):1378–82, 2016) Given this current situation, it is apparent that a careful review of clinical evidences supporting the use of opioid medications is necessary to guide our treatment approaches in the management of complex chronic abdominal pain patients. This review is set out to analyze efficacy of opioid medications for chronic abdominal pain.
Recent Findings
The literature referenced was obtained via a computer search with Google Scholar, Pubmed, Medline, and EMbase. The search terms used included Opioid, Oxycodone, Buprenorphine, Morphine, Fentanyl, Oxymorphone, Hydromorphone, chronic abdominal pain, Crohn’s disease, and pancreatitis. All studies were considered eligible for inclusion if they were clinical studies evaluating the efficacy of opioid medications for chronic abdominal pain. Two studies were found according to these criteria.
Summary
Chronic abdominal pain is a challenging medical condition in our daily practice. This condition often requires opioid medications when other treatments fail. This review provided very limited clinical evidence to support long-term opioid use for chronic abdominal pain. Given recent CDC report of opioid epidemic, it is prudent to use the best medical practice with appropriate evaluation of psychological comorbidities, urine drug screening, prescription drug monitor, and opioid treatment agreements to minimize adverse side effects related to opioids. Furthermore, well-designed clinical trials are needed to evaluate the effectiveness of long-term use of opioid medications, and more clinical research on which opioid medication is more effective for chronic abdominal pain.
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References
Ammann RW, Buehler H, Muench R, Freiburghaus AW, Siegenthaler W. Differences in the natural history of idiopathic (nonalcoholic) and alcoholic chronic pancreatitis. A comparative long-term study of 287 patients. Pancreas. 1987;2(4):368–77.
Bradley EL 3rd. Pancreatic duct pressure in chronic pancreatitis. Am J Surg. 1982;144(3):313–6.
Makrauer FL, Antonioli DA, Banks PA. Duodenal stenosis in chronic pancreatitis: clinicopathological correlations. Dig Dis Sci. 1982;27(6):525–32.
Bielefeldt K, Davis B, Binion DG. Pain and inflammatory bowel disease. Inflamm Bowel Dis. 2009;15(5):778–88. doi:10.1002/ibd.20848.
Siegel CA, MacDermott RP. Is chronic pain an extraintestinal manifestation of IBD? Inflamm Bowel Dis. 2009;15(5):769–71. doi:10.1002/ibd.20844.
Cross RK, Wilson KT, Binion DG. Narcotic use in patients with Crohn’s disease. Am J Gastroenterol. 2005;100(10):2225–9. doi:10.1111/j.1572-0241.2005.00256.x.
Edwards JT, Radford-Smith GL, Florin TH. Chronic narcotic use in inflammatory bowel disease patients: prevalence and clinical characteristics. J Gastroenterol Hepatol. 2001;16(11):1235–8.
Grover M, Herfarth H, Drossman DA. The functional-organic dichotomy: postinfectious irritable bowel syndrome and inflammatory bowel disease-irritable bowel syndrome. Clin Gastroenterol Hepatol. 2009;7(1):48–53. doi:10.1016/j.cgh.2008.08.032.
LJ P. Prescription drug overdose: a US epidemic. Centers for Disease Control and Prevention. CDC Grand Rounds. May 23, 2016.
Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016;64(50–51):1378–82. doi:10.15585/mmwr.mm6450a3.
Niemann T, Madsen LG, Larsen S, Thorsgaard N. Opioid treatment of painful chronic pancreatitis. Int J Pancreatol. 2000;27(3):235–40.
Sanford D, Thornley P, Teriaky A, Chande N, Gregor J. Opioid use is associated with decreased quality of life in patients with Crohn’s disease. Saudi J Gastroenterol. 2014;20(3):182–7. doi:10.4103/1319-3767.133020.
Aqua K, Gimbel JS, Singla N, Ma T, Ahdieh H, Kerwin R. Efficacy and tolerability of oxymorphone immediate release for acute postoperative pain after abdominal surgery: a randomized, double-blind, active- and placebo-controlled, parallel-group trial. Clin Ther. 2007;29(6):1000–12. doi:10.1016/j.clinthera.2007.06.001.
Singla N, Pong A, Newman K, Group MDS. Combination oxycodone 5 mg/ibuprofen 400 mg for the treatment of pain after abdominal or pelvic surgery in women: a randomized, double-blind, placebo- and active-controlled parallel-group study. Clin Ther. 2005;27(1):45–57. doi:10.1016/j.clinthera.2005.01.010.
Basurto Ona X, Rigau Comas D, Urrutia G. Opioids for acute pancreatitis pain. Cochrane Database Syst Rev. 2013;7:CD009179. doi:10.1002/14651858.CD009179.pub2.
Boudreau D, Von Korff M, Rutter CM, Saunders K, Ray GT, Sullivan MD, et al. Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiol Drug Saf. 2009;18(12):1166–75. doi:10.1002/pds.1833.
Furlan A, Chaparro LE, Irvin E, Mailis-Gagnon A. A comparison between enriched and nonenriched enrollment randomized withdrawal trials of opioids for chronic noncancer pain. Pain Res Manag. 2011;16(5):337–51.
Gordon A, Callaghan D, Spink D, Cloutier C, Dzongowski P, O'Mahony W, et al. Buprenorphine transdermal system in adults with chronic low back pain: a randomized, double-blind, placebo-controlled crossover study, followed by an open-label extension phase. Clin Ther. 2010;32(5):844–60. doi:10.1016/j.clinthera.2010.04.018.
Hale M, Khan A, Kutch M, Li S. Once-daily OROS hydromorphone ER compared with placebo in opioid-tolerant patients with chronic low back pain. Curr Med Res Opin. 2010;26(6):1505–18. doi:10.1185/03007995.2010.484723.
Tennant F. Why oral opioids may not be effective in a subset of chronic pain patients. Postgrad Med. 2016;128(1):18–22. doi:10.1080/00325481.2016.1128306.
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. doi:10.5056/jnm.2013.19.1.94.
Drossman D, Szigethy E. The narcotic bowel syndrome: a recent update. Am J Gastroenterol Suppl. 2014;2(1):22–30. doi:10.1038/ajgsup.2014.6.
OL KS. When should narcotic bowel syndrome be suspected? US Pharm. 2011;36:41–4.
Grunkemeier DM, Cassara JE, Dalton CB, Drossman DA. The narcotic bowel syndrome: clinical features, pathophysiology, and management. Clin Gastroenterol Hepatol. 2007;5(10):1126–1139; quiz 1-2. doi:10.1016/j.cgh.2007.06.013.
Choung RS, Locke GR 3rd, Zinsmeister AR, Schleck CD, Talley NJ. Psychosocial distress and somatic symptoms in community subjects with irritable bowel syndrome: a psychological component is the rule. Am J Gastroenterol. 2009;104(7):1772–9. doi:10.1038/ajg.2009.239.
Chitkara DK, van Tilburg MA, Blois-Martin N, Whitehead WE. Early life risk factors that contribute to irritable bowel syndrome in adults: a systematic review. Am J Gastroenterol. 2008;103(3):765–774; quiz 75. doi:10.1111/j.1572-0241.2007.01722.x.
Rome JD, Townsend CO, Bruce BK, Sletten CD, Luedtke CA, Hodgson JE. Chronic noncancer pain rehabilitation with opioid withdrawal: comparison of treatment outcomes based on opioid use status at admission. Mayo Clin Proc. 2004;79(6):759–68. doi:10.4065/79.6.759.
Sullivan MD, Edlund MJ, Fan MY, Devries A, Brennan Braden J, Martin BC. Trends in use of opioids for non-cancer pain conditions 2000-2005 in commercial and Medicaid insurance plans: the TROUP study. Pain. 2008;138(2):440–9. doi:10.1016/j.pain.2008.04.027.
Olsen Y, Daumit GL, Ford DE. Opioid prescriptions by U.S. primary care physicians from 1992 to 2001. J Pain. 2006;7(4):225–35. doi:10.1016/j.jpain.2005.11.006.
Starrels JL, Becker WC, Alford DP, Kapoor A, Williams AR, Turner BJ. Systematic review: treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Ann Intern Med. 2010;152(11):712–20. doi:10.7326/0003-4819-152-11-201006010-00004.
Volkow ND, McLellan TA. Curtailing diversion and abuse of opioid analgesics without jeopardizing pain treatment. JAMA. 2011;305(13):1346–7. doi:10.1001/jama. 2011.369.
Warner MCL, Makuc DM, Anderson RN. Drug poisoning deaths in the United States, 1980 –2008. NCHS Data Brief. 2011:1–8.
Toblin RL, Paulozzi LJ, Logan JE, Hall AJ, Kaplan JA. Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review. J Clin Psychiatry. 2010;71(4):491–6. doi:10.4088/JCP.09m05567blu.
Solanki DR, Koyyalagunta D, Shah RV, Silverman SM, Manchikanti L. Monitoring opioid adherence in chronic pain patients: assessment of risk of substance misuse. Pain Physician. 2011;14(2):E119–31.
Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85–92. doi:10.7326/0003-4819-152-2-201001190-00006.
Katz N, Fanciullo GJ. Role of urine toxicology testing in the management of chronic opioid therapy. Clin J Pain. 2002;18(4 Suppl):S76–82.
Katz NP, Sherburne S, Beach M, Rose RJ, Vielguth J, Bradley J, et al. Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy. Anesth Analg. 2003;97(4):1097–102. table of contents
Manchikanti L, Whitfield E, Pallone F. Evolution of the National All Schedules Prescription Electronic Reporting Act (NASPER): a public law for balancing treatment of pain and drug abuse and diversion. Pain Physician. 2005;8(4):335–47.
Wang J, Christo PJ. The influence of prescription monitoring programs on chronic pain management. Pain Physician. 2009;12(3):507–15.
Manchikanti L, Manchukonda R, Pampati V, Damron KS, Brandon DE, Cash KA, et al. Does random urine drug testing reduce illicit drug use in chronic pain patients receiving opioids? Pain Physician. 2006;9(2):123–9.
Manchikanti L, Boswell MV, Singh V. Monitoring of patients receiving long-term opioid therapy. Anesth Analg. 2004;99(1):304. author reply -5
Roskos SE, Keenum AJ, Newman LM, Wallace LS. Literacy demands and formatting characteristics of opioid contracts in chronic nonmalignant pain management. J Pain. 2007;8(10):753–8. doi:10.1016/j.jpain.2007.01.005.
Arnold RM, Han PK, Seltzer D. Opioid contracts in chronic nonmalignant pain management: objectives and uncertainties. Am J Med. 2006;119(4):292–6. doi:10.1016/j.amjmed.2005.09.019.
Riviere PJ. Peripheral kappa-opioid agonists for visceral pain. Br J Pharmacol. 2004;141(8):1331–4. doi:10.1038/sj.bjp.0705763.
Ross FB, Smith MT. The intrinsic antinociceptive effects of oxycodone appear to be kappa-opioid receptor mediated. Pain. 1997;73(2):151–7.
Eisenach JC, Carpenter R, Curry R. Analgesia from a peripherally active kappa-opioid receptor agonist in patients with chronic pancreatitis. Pain. 2003;101(1–2):89–95.
Staahl C, Dimcevski G, Andersen SD, Thorsgaard N, Christrup LL, Arendt-Nielsen L, et al. Differential effect of opioids in patients with chronic pancreatitis: an experimental pain study. Scand J Gastroenterol. 2007;42(3):383–90. doi:10.1080/00365520601014414.
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Dajie Wang is a section editor for Current Pain and Headache Reports.
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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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This article is part of the Topical Collection on Anesthetic Techniques in Pain Management
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Wang, D. Opioid Medications in the Management of Chronic Abdominal Pain. Curr Pain Headache Rep 21, 40 (2017). https://doi.org/10.1007/s11916-017-0640-x
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DOI: https://doi.org/10.1007/s11916-017-0640-x