Buprenorphine-naloxone combo effective treatment of narcotic bowel syndrome

The combination of buprenorphine and naloxone should be investigated as a potential treatment for narcotic bowel syndrome. The drugs seem to work together to address the underlying pathology of the syndrome. Findings from a brief research report are published in Annals of Internal Medicine.

Narcotic bowel syndrome (NBS) is a subset of opioid bowel dysfunction that is characterized by chronic or frequently recurring abdominal pain that worsens with continued or escalating dosages of narcotics. This syndrome is underrecognized and may be becoming more prevalent. 

It is a chronic pain syndrome that occurs with opioid use and persists as opioid treatment is continued or escalated. More than half of patients with this syndrome who undergo opioid detoxification return to opioid use within a few months because of continued pain.

Opioid detoxification regimens vary between centres, but frequently include tapering or substitution of opioids and concomitant co-administration of antidepressants, anxiolytics, and psychological therapies.

Researchers from the University of Rochester reported the case of a 41-year old woman who had been taking fast-acting opioids for pain for 8 years, with continued episodes of abdominal pain, nausea, and vomiting, requiring hundreds of hospital visits. When other causes of pain had been ruled out and all other treatments failed, the clinicians treated her narcotic bowel syndrome with buprenorphine and naloxone. The patient reported greatly improved abdominal pain over the first few days, and her pain resolved entirely after 1 week. She had no further episodes of vomiting, and her nausea resolved almost entirely after 1 month.

According to the researchers, this approach may work because the combination of a narcotic partial agonist with a low-dose antagonist could result in improved pain control because the antagonist would block Gs pathways.

For further reference log on to:http://annals.org/aim/article/doi/10.7326/L19-0798