Identifying the Condition
Although narcotic bowel syndrome is not technically a functional GI disorder (differing from other functional GI disorders by having substances – opioids – that produce the symptoms, and their avoidance possibly leading to recovery), the Rome IV established criteria for diagnosing the condition.
Diagnostic criteria(a) for narcotic bowel syndrome/opioid-induced gastrointestinal hyperalgesia:
Must include all of the following:
- Chronic or frequently recurring abdominal pain(b) that iss treated with acute high-dose or chronic narcotics
- The nature and intensity of the pain is not explained by a current or previous GI diagnosis(c)
- Two or more of the following:
- The pain worsens or incompletely resolves with continued or escalating dosages of narcotics
- There is marked worsening of pain when the narcotic dose wanes and improvement when narcotics are re-instituted (soar and crash)
- There is a progression of the frequency, duration, and intensity of pain episodes
(a) Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.
(b) Pain must occur most days.
(c) A patient may have a structural diagnosis (eg, inflammatory bowel disease, chronic pancreatitis), but the character or activity of the disease process is not sufficient to explain the pain.
The key to diagnosis is the recognition that long-term or increasing dosages of narcotics lead to continued or worsening symptoms rather than benefit.