Opioid Use for Abdominal Pain, A Bad Idea

In an article from Anesthesiology News “Opioid Use for Abdominal Pain Sees Recent Spike” they point out that from 1997 to 2008, opioid prescriptions for chronic abdominal pain more than doubled in the U.S. (study from Clinical Grastroenterology and Hepatology (2011;9:1078-1085). This points to an increasing problem I see in my clinic, that opioids are handed out because they are “stronger,” not only for musculoskeletal pain, but for conditions where they are clearly contraindicated like gastrointestinal problems. In the case of musculoskeletal pain, opioids can be of very limited value, though it varies case to case. With their danger of addiction and gastrointestinal and cognitive side effects, the threshold for prescribing should be high. More on my practice here.

The investigators noted that this increase in opioid prescriptions has been problematic, in part because no study has shown opioids to be effective for treating chronic abdominal pain. When used over long periods of time, opioids may worsen other gastrointestinal symptoms, such as constipation, nausea and vomiting.

The growing use of opioids to treat “persistent abdominal pain highlights the growing challenges clinicians face trying to manage chronic illness without the time, infrastructure and incentives needed to take the integrated approach that experts suggest,” said lead study author Spencer D. Dorn, MD, MPH, assistant professor of medicine at the University of North Carolina at Chapel Hill, in a statement.