Dramatic nationwide rise in opioid use for chronic abdominal pain

Across U.S. outpatient clinics between 1997 and 2008, opioid prescriptions for chronic abdominal pain more than doubled, according to a new study in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association.

Chronic abdominal pain is a common symptom and a frequent reason for health-care visits. Because it is often incurable, clinicians often find it challenging to help their patients manage their abdominal pain over time.

"Opioid use for 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 Spencer D. Dorn, MD, MPH, of the University of North Carolina and lead author of the study. "Writing a prescription for a pain killer may be the path of least resistance; doing so may satisfy the patient's demand for relief and mitigate the clinician's possible feelings of inadequacy."

The researchers concluded that the dramatic nationwide rise in opioid use to treat chronic abdominal pain is concerning for several reasons. First, using opioids to treat non-cancer chronic pain is supported by very limited evidence. Second, opioids are frequently misused and sometimes abused. Finally, when used over long periods of time, opioids may trigger other gastrointestinal symptoms, such as constipation, nausea and vomiting, and may even paradoxically worsen abdominal pain.

The researchers speculate that the growth in opioid use has likely been driven by numerous factors, including a tendency to generalize recommendations for the use of opioids in treating pain, campaigns to recognize pain as the "fifth vital sign," and widespread direct-to-consumer advertising, which, in the case of OxyContin, was considered misleading and illegal.

Source: American Gastroenterological Association