The number of prescriptions of opioids written for patients with chronic abdominal pain has more than doubled in the past decade, according to a study published in the December issue of Clinical Gastroenterology and Hepatology.
Chronic abdominal pain is common, yet a challenge to treat, so clinicians have increasingly prescribed opioids for patients with this condition. According to one report from a tertiary care center, 13% of patients with Crohn’s disease and nearly 20% of patients with irritable bowel syndrome reported opioid use.
The widespread use of opioids to treat chronic abdominal pain is a concern, because it is not clear if opioids are effective and because the drugs are frequently misused or abused.
Spencer Dorn and colleagues analyzed 2 national medical databases to identify trends and factors associated with prescription of opioids for chronic abdominal pain. They classified opioid analgesics as drugs from the Multum Therapeutic Classification category for narcotic analgesics and narcotic analgesic combinations; tramadol, classified as a miscellaneous analgesic in this system, was included in the analysis.
Dorn et al. found that although the total number of visits for chronic abdominal pain decreased over time, the percentage of visits at which an opioid was prescribed more than doubled, from 5.9% in the period of 1997–1999 to 12.2% in period of 2006–2008 (see figure).
Patients that were 25 to 40 years old were the most likely to receive a prescription, whereas the uninsured and African American patients were the least likely.
The authors speculate that opioid use for chronic abdominal pain has increased because of misunderstandings of recommendations for opioid use, as well as advertising. They said it might also reflect the challenges clinicians face trying to manage patients with chronic disorders, without the time, infrastructure, or incentives necessary to take the integrated approach that experts suggest. Dorn et al. state that “writing a prescription for a pain killer may be the path of least resistance; doing so may both satisfy the patient’s demand for relief and mitigate the clinician’s possible feelings of inadequacy.”
However, the increase is a problem, because opioids have not been adequately assessed for chronic, noncancer-related abdominal pain or been proven to improve functional status or health-related quality of life. Long-term use of opioids can actually induce gastrointestinal symptoms, such as constipation, lower abdominal pain, nausea, and emesis. Some patients even develop narcotic bowel syndrome—chronic or frequently recurring abdominal pain that worsens despite continued or increased opioid dosage.
It is not clear why the number of visits for chronic abdominal pain decreased during the observation period. The authors propose that it might result from a gradual decrease in the prevalence of chronic abdominal pain, or because patients have increasingly sought care in nonambulatory settings.
Dorn et al. propose further studies to determine the reasons for and consequences of these trends.
More Information on Chronic Abdominal Pain:
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Dorn SD, Meek PD, Shah ND. Increasing frequency of opioid prescriptions for chronic abdominal pain in us outpatient clinics. Clin Gastroenterol and Hepatol 2011; 9:1078–1085.e1