From the Guidelines
Narcotics can worsen Crohn's disease symptoms, particularly abdominal pain and constipation, and their use should be avoided whenever possible. Opioids like morphine, oxycodone, hydrocodone, and codeine slow down intestinal motility, which can lead to severe constipation in patients with Crohn's disease [ 1 ]. This constipation can increase abdominal distension, pain, and potentially trigger or worsen disease flares. Opioids may also mask important symptoms that could indicate disease progression or complications, making it difficult for healthcare providers to accurately assess disease activity.
Key Considerations
- The use of opioids in patients with Crohn's disease is associated with an increased risk of narcotic bowel syndrome, a condition characterized by chronic or frequently recurring paradoxic increases in abdominal pain, despite continued or escalating dosages of opioids [ 1 ].
- Patients with Crohn's disease who use opioids long-term are at risk for development of narcotic bowel syndrome, which can be difficult to diagnose and is associated with significant impairment in quality of life [ 1 ].
- For pain management in Crohn's disease, non-opioid alternatives are generally preferred, including acetaminophen, certain non-steroidal anti-inflammatory drugs (with caution), antispasmodics like dicyclomine, or specific pain modulators like amitriptyline or gabapentin [ 1 ].
Recommendations
- Avoid the use of narcotics in patients with Crohn's disease whenever possible, and instead opt for non-opioid alternatives for pain management [ 1 ].
- If narcotics are absolutely necessary for short-term severe pain, they should be used at the lowest effective dose for the shortest possible duration, along with preventive measures for constipation such as stool softeners, increased fluid intake, and possibly prescription medications like methylnaltrexone that counter opioid-induced constipation without affecting pain control [ 1 ].
From the FDA Drug Label
Effects on the Gastrointestinal Tract and Other Smooth Muscle: Morphine causes a reduction in motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum Digestion of food in the small intestine is delayed and propulsive contractions are decreased. Propulsive peristaltic waves in the colon are decreased, while tone may be increased to the point of spasm, resulting in constipation.
The most frequent of these included nausea, constipation, vomiting, headache, pruritus, insomnia, dizziness, asthenia, and somnolence.
Gastrointestinal disorders: abdominal pain, dry mouth, diarrhea, dyspepsia, dysphagia, glossitis, nausea, vomiting
Narcotics can exacerbate abdominal pain and constipation. The use of narcotics like morphine and oxycodone can lead to:
- Reduced motility in the gastrointestinal tract
- Increased smooth muscle tone, resulting in constipation
- Abdominal pain
- Nausea and vomiting
- Other gastrointestinal disorders
These effects can worsen symptoms in patients with Crohn's disease, particularly abdominal pain and constipation 2, 3.
From the Research
Narcotics and Crohn's Disease
- Narcotics are not directly mentioned in the provided studies as a factor that can worsen Crohn's disease with abdominal pain and constipation 4, 5, 6, 7, 8.
- However, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen has been associated with an increased risk of active Crohn's disease, particularly in patients who use these medications regularly (≥5 times/month) 5.
- The studies suggest that the management of Crohn's disease should focus on controlling inflammation, inducing and maintaining remission, and preventing complications 4, 6, 8.
- Treatment options for Crohn's disease include corticosteroids, biologics, immunomodulators, and surgery, and the choice of treatment depends on the severity of the disease and the patient's individual needs 4, 6, 7, 8.
Abdominal Pain and Constipation in Crohn's Disease
- Abdominal pain and constipation are common symptoms of Crohn's disease, and their management is an important part of the treatment plan 6.
- The use of narcotics for pain management in Crohn's disease is not explicitly discussed in the provided studies, but it is generally recommended to use the minimum effective dose of pain medication to avoid exacerbating constipation and other symptoms 6.
- Other treatment options, such as fiber supplements and bowel habit modification, may be recommended to manage constipation in patients with Crohn's disease 6.