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Current Treatment Options in Gastroenterology
Published in: Current Treatment Options in Gastroenterology 4/2016

01-12-2016 | Motility (H Parkman and R Schey, Section Editors)

Opioids and GI Motility—Friend or Foe?

Authors: Allen A. Lee, MD, William L. Hasler, MD

Published in: Current Treatment Options in Gastroenterology | Issue 4/2016

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Opinion statement

The use of opioids for the treatment of chronic non-cancer pain is growing at an alarming rate. Opioid-induced bowel dysfunction (OBD) is a common adverse effect of long-term opioid treatment manifesting as constipation, nausea, and vomiting. These effects are primarily mediated by peripheral μ-opioid receptors with resultant altered GI motility and function. As a result, patients may present with opioid-induced constipation (OIC), opioid-induced nausea and vomiting (OINV), and/or narcotic bowel syndrome (NBS). This often leads to decreased quality of life and in many cases, discontinuation of opioid therapy. There is limited evidence to support the use of traditional anti-emetics and laxatives in the treatment of OBD. Tapering the dose of opioids, switching to transdermal application, opioid rotation, or dual-action opioids, such as tapentadol, may be helpful in the treatment of OBD. Novel agents, such as peripherally acting μ-opioid receptor antagonists which target the cause of OIC, show promise in the treatment of OBD and should be considered when conventional laxatives fail. This chapter will review the pathophysiology of OBD, including OINV and OIC, and treatment options available.
Literature
1.
Verhaak PF, Kerssens JJ, Dekker J, Sorbi MJ, Bensing JM. Prevalence of chronic benign pain disorder among adults: a review of the literature. Pain. 1998;77(3):231–9.CrossRefPubMed
2.
Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain. 2001;89(2–3):127–34.CrossRefPubMed
3.
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain Lond Engl. 2006;10(4):287–333.CrossRef
4.
Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving pain in America: a blueprint for transforming prevention, care, education, and research [Internet]. Washington (DC): National Academies Press (US); 2011 [Cited 2016 mar 28]. (The National Academies Collection: Reports funded by National Institutes of Health). Available from: http://​www.​ncbi.​nlm.​nih.​gov/​books/​NBK91497/​.
5.
Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, et al. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008;9(10):883–91.CrossRefPubMed
6.
Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008;11(2 Suppl):S63–88.PubMed
7.
Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251–8.CrossRefPubMedPubMedCentral
8.
Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85–92.CrossRefPubMedPubMedCentral
9.
Kalso E, Edwards JE, Moore RA, McQuay HJ. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain. 2004;112(3):372–80.CrossRefPubMed
10.
Tuteja AK, Biskupiak J, Stoddard GJ, Lipman AG. Opioid-induced bowel disorders and narcotic bowel syndrome in patients with chronic non-cancer pain. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2010;22(4):424–30 e96.CrossRef
11.
Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, Milanova T, Williamson R. The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European patient survey (PROBE 1). Pain Med Malden Mass. 2009;10(1):35–42.CrossRef
12.
Kurz A, Sessler DI. Opioid-induced bowel dysfunction: pathophysiology and potential new therapies. Drugs. 2003;63(7):649–71.CrossRefPubMed
13.
Camilleri M. Opioid-induced constipation: challenges and therapeutic opportunities. Am J Gastroenterol. 2011;106(5):835–42 quiz 843.CrossRefPubMed
14••.
Dorn S, Lembo A, Cremonini F. Opioid-induced bowel dysfunction: epidemiology, pathophysiology, diagnosis, and initial therapeutic approach. Am J Gastroenterol Suppl. 2014;2(1):31–7 This article discusses the pathophysiology behind opioid-induced bowel dysfunction and reviews management strategies.CrossRefPubMed
15.
16.
Pasternak GW. Pharmacological mechanisms of opioid analgesics. Clin Neuropharmacol. 1993;16(1):1–18.CrossRefPubMed
17.
Bagnol D, Mansour A, Akil H, Watson SJ. Cellular localization and distribution of the cloned mu and kappa opioid receptors in rat gastrointestinal tract. Neuroscience. 1997;81(2):579–91.CrossRefPubMed
18.
Fickel J, Bagnol D, Watson SJ, Akil H. Opioid receptor expression in the rat gastrointestinal tract: a quantitative study with comparison to the brain. Brain Res Mol Brain Res. 1997;46(1–2):1–8.CrossRefPubMed
19••.
Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Simren M, et al. Bowel disorders. Gastroenterology. 2016;150(6):1393–407.e5 This article details the newest Rome IV criteria for functional bowel disorders, including opioid-induced constipation, and reviews treatment options for these conditions.CrossRef
20.
Kaufman PN, Krevsky B, Malmud LS, Maurer AH, Somers MB, Siegel JA, et al. Role of opiate receptors in the regulation of colonic transit. Gastroenterology. 1988;94(6):1351–6.CrossRefPubMed
21.
De Luca A, Coupar IM. Insights into opioid action in the intestinal tract. Pharmacol Ther. 1996;69(2):103–15.CrossRefPubMed
22.
De Schepper HU, Cremonini F, Park M-I, Camilleri M. Opioids and the gut: pharmacology and current clinical experience. Neurogastroenterol Motil. 2004;16(4):383–94.CrossRefPubMed
23.
Rauck RL. Treatment of opioid-induced constipation: focus on the peripheral μ-opioid receptor antagonist methylnaltrexone. Drugs. 2013;73(12):1297–306.CrossRefPubMed
24.
Manchikanti L, Abdi S, Atluri S, Balog CC, Benyamin RM, Boswell MV, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part 2—guidance. Pain Physician. 2012;15(3 Suppl):S67–116.PubMed
25.
Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012;13(2):e58–68.CrossRefPubMed
26.
Candy B, Jones L, Goodman ML, Drake R, Tookman A. Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Cochrane Database Syst Rev. 2011;(1):CD003448.
27.
Chamberlain BH, Cross K, Winston JL, Thomas J, Wang W, Su C, et al. Methylnaltrexone treatment of opioid-induced constipation in patients with advanced illness. J Pain Symptom Manag. 2009;38(5):683–90.CrossRef
28.
Ishihara M, Ikesue H, Matsunaga H, Suemaru K, Kitaichi K, Suetsugu K, et al. A multi-institutional study analyzing effect of prophylactic medication for prevention of opioid-induced gastrointestinal dysfunction. Clin J Pain. 2012;28(5):373–81.CrossRefPubMed
29.
Bao HF, Liu L, Self J, Duke BJ, Ueno R, Eaton DCA. Synthetic prostone activates apical chloride channels in A6 epithelial cells. Am J Physiol Gastrointest Liver Physiol. 2008;295(2):G234–51.CrossRefPubMedPubMedCentral
30.
Camilleri M, Bharucha AE, Ueno R, Burton D, Thomforde GM, Baxter K, et al. Effect of a selective chloride channel activator, lubiprostone, on gastrointestinal transit, gastric sensory, and motor functions in healthy volunteers. Am J Physiol Gastrointest Liver Physiol. 2006;290(5):G942–7.CrossRefPubMed
31.
Jamal MM, Adams AB, Jansen J-P, Webster LRA. Randomized, placebo-controlled trial of lubiprostone for opioid-induced constipation in chronic Noncancer pain. Am J Gastroenterol. 2015;110(5):725–32.CrossRefPubMedPubMedCentral
32.
Cryer B, Katz S, Vallejo R, Popescu A, Ueno R. A randomized study of lubiprostone for opioid-induced constipation in patients with chronic noncancer pain. Pain Med Malden Mass. 2014;15(11):1825–34.CrossRef
33•.
Brenner DM, Chey WD. An evidence-based review of novel and emerging therapies for constipation in patients taking opioid analgesics. Am J Gastroenterol Suppl. 2014;2(1):38–46 This article reviews novel therapies for opioid-induced constipation including peripherally acting mu-opioid receptors and secretagogue class laxatives.CrossRef
34.
35.
Cuppoletti J, Chakrabarti J, Tewari K, Malinowska DH. Methadone but not morphine inhibits lubiprostone-stimulated Cl- currents in T84 intestinal cells and recombinant human ClC-2, but not CFTR Cl- currents. Cell Biochem Biophys. 2013;66(1):53–63.CrossRefPubMed
36.
Spierings E, Drossman D, Cryer B, Losch-Beridon T, Ueno R. A pooled analysis of response to lubiprostone in patients with opioid-induced constipation receiving non-methadone versus methadone. Gastroenterology. 146(5):S360.
37.
De Maeyer JH, Lefebvre RA, Schuurkes JAJ. 5-HT4 receptor agonists: similar but not the same. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2008;20(2):99–112.CrossRef
38.
Sloots CEJ, Rykx A, Cools M, Kerstens R, De Pauw M. Efficacy and safety of prucalopride in patients with chronic noncancer pain suffering from opioid-induced constipation. Dig Dis Sci. 2010;55(10):2912–21.CrossRefPubMedPubMedCentral
39.
Russell J, Bass P, Goldberg LI, Schuster CR, Merz H. Antagonism of gut, but not central effects of morphine with quaternary narcotic antagonists. Eur J Pharmacol. 1982;78(3):255–61.CrossRefPubMed
40.
Foss JF. A Review of the potential role of methylnaltrexone in opioid bowel dysfunction. Am J Surg. 2001;182(5A Suppl):19S–26S.CrossRefPubMed
41.
Michna E, Blonsky ER, Schulman S, Tzanis E, Manley A, Zhang H, et al. Subcutaneous methylnaltrexone for treatment of opioid-induced constipation in patients with chronic, nonmalignant pain: a randomized controlled study. J Pain Off J Am Pain Soc. 2011;12(5):554–62.CrossRef
42.
Webster L, Michna E, Khan A, Israel R, Manley A, Zhang H, et al. The long-term safety of subcutaneous methylnaltrexone for the treatment of opioid-induced constipation in patients with chronic nonmalignant pain. J Pain. 2011;12(4):P70.
43.
Siemens W, Becker G. Methylnaltrexone for opioid-induced constipation: review and meta-analyses for objective plus subjective efficacy and safety outcomes. Ther Clin Risk Manag. 2016;12:401–12.CrossRefPubMedPubMedCentral
44.
Chey WD, Webster L, Sostek M, Lappalainen J, Barker PN, Tack J. Naloxegol for opioid-induced constipation in patients with noncancer pain. N Engl J Med. 2014;370(25):2387–96.CrossRefPubMed
45.
Webster L, Chey WD, Tack J, Lappalainen J, Diva U, Sostek M. Randomised clinical trial: the long-term safety and tolerability of naloxegol in patients with pain and opioid-induced constipation. Aliment Pharmacol Ther. 2014;40(7):771–9.CrossRefPubMed
46.
Jansen J-P, Lorch D, Langan J, Lasko B, Hermanns K, Kleoudis CS, et al. A randomized, placebo-controlled phase 3 trial (study SB-767905/012) of alvimopan for opioid-induced bowel dysfunction in patients with non-cancer pain. J Pain Off J Am Pain Soc. 2011;12(2):185–93.CrossRef
47.
Ford AC, Brenner DM, Schoenfeld PS. Efficacy of pharmacological therapies for the treatment of opioid-induced constipation: systematic review and meta-analysis. Am J Gastroenterol. 2013;108(10):1566–74 quiz 1575.CrossRefPubMed
48.
Holder RM, Rhee D. Novel oral therapies for opioid-induced bowel dysfunction in patients with chronic noncancer pain. Pharmacotherapy. 2016;36(3):287–99.CrossRefPubMed
49.
Webster L, Brenner D, Rolleri R, Barrett A, Bortey E, Paterson C, et al. All-cause mortality in placebo-controlled trials of methylnaltrexone: a pooled analysis. Am J Gastroenterol. 2013;108(S1):1886.
50.
Armstrong SR, Campbell CB, Richardson CL, Vickery RG, Tsuruda PR, Long DD, et al. The in vivo pharmacodynamics of the novel opioid receptor antagonist, TD-1211, in models of opioid-induced gastrointestinal and CNS activity. Naunyn Schmiedeberg’s Arch Pharmacol. 2013;386(6):471–8.CrossRef
51.
52.
Hale M, Wild J, Reddy J, Yamada T, Ferreira JCA. Efficacy and safety of Naldemedine for the treatment of opioid-induced constipation in subjects with chronic non-cancer pain receiving opioid therapy: results from two phase 3 clinical trials. Gastroenterology. 2016;150(4):S598.CrossRef
53.
de Stoutz ND, Bruera E, Suarez-Almazor M. Opioid rotation for toxicity reduction in terminal cancer patients. J Pain Symptom Manag. 1995;10(5):378–84.CrossRef
54.
Quigley C. Opioid switching to improve pain relief and drug tolerability. Cochrane Database Syst Rev. 2004;(3):CD004847.
55.
Allan L, Hays H, Jensen NH, de Waroux BL, Bolt M, Donald R, et al. Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain. BMJ. 2001;322(7295):1154–8.CrossRefPubMedPubMedCentral
56.
Donner B, Zenz M, Strumpf M, Raber M. Long-term treatment of cancer pain with transdermal fentanyl. J Pain Symptom Manag. 1998;15(3):168–75.CrossRef
57.
Ahmedzai S, Brooks D. Transdermal fentanyl versus sustained-release oral morphine in cancer pain: preference, efficacy, and quality of life. The TTS-fentanyl comparative trial group. J Pain Symptom Manag. 1997;13(5):254–61.CrossRef
58.
Weschules DJ, Bain KT, Reifsnyder J, McMath JA, Kupperman DE, Gallagher RM, et al. Toward evidence-based prescribing at end of life: a comparative analysis of sustained-release morphine, oxycodone, and transdermal fentanyl, with pain, constipation, and caregiver interaction outcomes in hospice patients. Pain Med Malden Mass. 2006;7(4):320–9.CrossRef
59.
Moore RA, McQuay HJ. Prevalence of opioid adverse events in chronic non-malignant pain: systematic review of randomised trials of oral opioids. Arthritis Res Ther. 2005;7(5):R1046–51.CrossRefPubMedPubMedCentral
60.
Porreca F, Ossipov MH. Nausea and vomiting side effects with opioid analgesics during treatment of chronic pain: mechanisms, implications, and management options. Pain Med Malden Mass. 2009;10(4):654–62.CrossRef
61.
Salzman RT, Roberts MS, Wild J, Fabian C, Reder RF, Goldenheim PD. Can a controlled-release oral dose form of oxycodone be used as readily as an immediate-release form for the purpose of titrating to stable pain control? J Pain Symptom Manag. 1999;18(4):271–9.CrossRef
62.
Frank Porreca MHO. Nausea and vomiting side effects with opioid analgesics during treatment of chronic pain: mechanisms, implications, and management options. Pain Med Malden Mass. 2009;10(4):654–62.CrossRef
63.
Yates BJ, Miller AD, Lucot JB. Physiological basis and pharmacology of motion sickness: an update. Brain Res Bull. 1998;47(5):395–406.CrossRefPubMed
64.
Jongkamonwiwat N, Phansuwan-Pujito P, Sarapoke P, Chetsawang B, Casalotti SO, Forge A, et al. The presence of opioid receptors in rat inner ear. Hear Res. 2003;181(1–2):85–93.CrossRefPubMed
65.
Iasnetsov VV, Drozd IV, Shashkov VS. Emetic and antiemetic properties of regulatory peptides. Biull Eksp Biol Med. 1987;103(5):586–8.PubMed
66.
Barnes NM, Bunce KT, Naylor RJ, Rudd JA. The actions of fentanyl to inhibit drug-induced emesis. Neuropharmacology. 1991;30(10):1073–83.CrossRefPubMed
67.
Scotto di Fazano C, Vergne P, Grilo RM, Bertin P, Bonnet C, Trèves R. Preventive therapy for nausea and vomiting in patients on opioid therapy for non-malignant pain in rheumatology. Therapie. 2002;57(5):446–9.PubMed
68.
Kalso E, Vainio A. Morphine and oxycodone hydrochloride in the management of cancer pain. Clin Pharmacol Ther. 1990;47(5):639–46.CrossRefPubMed
69.
Finco G, Pintor M, Sanna D, Orrù G, Musu M, De Conno F, et al. Is target opioid therapy within sight? Minerva Anestesiol. 2012;78(4):462–72.PubMed
70.
Davis MP, Hallerberg G. Palliative Medicine Study Group of the Multinational Association of Supportive Care in Cancer. A systematic review of the treatment of nausea and/or vomiting in cancer unrelated to chemotherapy or radiation. J Pain Symptom Manag. 2010;39(4):756–67.CrossRef
71.
Hardy J, Daly S, McQuade B, Albertsson M, Chimontsi-Kypriou V, Stathopoulos P, et al. A double-blind, randomised, parallel group, multinational, multicentre study comparing a single dose of ondansetron 24 mg p.O. with placebo and metoclopramide 10 mg t.D.S. P.O. in the treatment of opioid-induced nausea and emesis in cancer patients. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2002;10(3):231–6.
72.
Rojas C, Thomas AG, Alt J, Stathis M, Zhang J, Rubenstein EB, et al. Palonosetron triggers 5-HT(3) receptor internalization and causes prolonged inhibition of receptor function. Eur J Pharmacol. 2010;626(2–3):193–9.CrossRefPubMed
73.
Kim YY, Moon SY, Song DU, Lee KH, Song JW, Kwon YE. Comparison of palonosetron with ondansetron in prevention of postoperative nausea and vomiting in patients receiving intravenous patient-controlled analgesia after gynecological laparoscopic surgery. Korean J Anesthesiol. 2013;64(2):122–6.
74.
Kovac AL, Eberhart L, Kotarski J, Clerici G, Apfel C, Palonosetron 04-07 Study Group. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo in preventing postoperative nausea and vomiting over a 72-h period. Anesth Analg. 2008;107(2):439–44.CrossRefPubMed
75.
Ariumi H, Saito R, Nago S, Hyakusoku M, Takano Y, Kamiya H. The role of tachykinin NK-1 receptors in the area postrema of ferrets in emesis. Neurosci Lett. 2000;286(2):123–6.CrossRefPubMed
76•.
Smith HS, Laufer A. Opioid induced nausea and vomiting. Eur J Pharmacol. 2014;722:67–78 This article details the pathophysiology behind opioid-induced nausea and vomiting and reviews management strategies for this condition.CrossRefPubMed
77.
Torigoe K, Nakahara K, Rahmadi M, Yoshizawa K, Horiuchi H, Hirayama S, et al. Usefulness of olanzapine as an adjunct to opioid treatment and for the treatment of neuropathic pain. Anesthesiology. 2012;116(1):159–69.CrossRefPubMed
78.
Jackson WC, Tavernier L. Olanzapine for intractable nausea in palliative care patients. J Palliat Med. 2003;6(2):251–5.CrossRefPubMed
79.
Passik SD, Lundberg J, Kirsh KL, Theobald D, Donaghy K, Holtsclaw E, et al. A pilot exploration of the antiemetic activity of olanzapine for the relief of nausea in patients with advanced cancer and pain. J Pain Symptom Manag. 2002;23(6):526–32.CrossRef
80.
Okamoto Y, Tsuneto S, Matsuda Y, Inoue T, Tanimukai H, Tazumi K, et al. A retrospective chart review of the antiemetic effectiveness of risperidone in refractory opioid-induced nausea and vomiting in advanced cancer patients. J Pain Symptom Manag. 2007;34(2):217–22.CrossRef
81.
Foss JF, Bass AS, Goldberg LI. Dose-related antagonism of the emetic effect of morphine by methylnaltrexone in dogs. J Clin Pharmacol. 1993;33(8):747–51.CrossRefPubMed
82.
Yuan CS, Foss JF. Gastric effects of methylnaltrexone on μ, κ and δ opioid agonists induced brainstem unitary responses. Neuropharmacology. 1999;38(3):425–32.CrossRefPubMed
83.
Wolff BG, Weese JL, Ludwig KA, Delaney CP, Stamos MJ, Michelassi F, et al. Postoperative ileus-related morbidity profile in patients treated with alvimopan after bowel resection. J Am Coll Surg. 2007;204(4):609–16.CrossRefPubMed
84.
Tzschentke TM, De V, Terlinden R, Hennies H-H, Lange C, Strassburger W, et al. Tapentadol hydrochloride: analgesic mu-opioid receptor agonist noradrenaline reuptake inhibitor. Drugs Future. 2006;31(12):1053–61.CrossRef
85.
Vorsanger G, Xiang J, Biondi D, Upmalis D, Delfgaauw J, Allard R, et al. Post hoc analyses of data from a 90-day clinical trial evaluating the tolerability and efficacy of tapentadol immediate release and oxycodone immediate release for the relief of moderate to severe pain in elderly and nonelderly patients. Pain Res Manag. 2011;16(4):245–51.CrossRefPubMedPubMedCentral
86.
Afilalo M, Etropolski MS, Kuperwasser B, Kelly K, Okamoto A, Van H, et al. Efficacy and safety of tapentadol extended release compared with oxycodone controlled release for the management of moderate to severe chronic pain related to osteoarthritis of the knee: a randomized, double-blind, placebo-and active-controlled phase III study. Clin Drug Investig. 2010;30(8):489–505.CrossRefPubMed
87.
Buynak R, Shapiro DY, Okamoto A, Hove IV, Rauschkolb C, Steup A, et al. Efficacy and safety of tapentadol extended release for the management of chronic low back pain: results of a prospective, randomized, double-blind, placebo- and active-controlled phase III study. Expert Opin Pharmacother. 2010;11(11):1787–804.CrossRefPubMed
88.
Lange B, Kuperwasser B, Okamoto A, Steup A, Häufel T, Ashworth J, et al. Efficacy and safety of tapentadol prolonged release for chronic osteoarthritis pain and low back pain. Adv Ther. 2010;27(6):381–99.CrossRefPubMed
89.
Wild JE, Grond S, Kuperwasser B, Gilbert J, McCann B, Lange B, et al. Long-term safety and tolerability of tapentadol extended release for the management of chronic low back pain or osteoarthritis pain. Pain Pract. 2010;10(5):416–27.CrossRefPubMed
90.
Webster L. Efficacy and safety of dual-opioid therapy in acute pain. Pain Med Malden Mass. 2012;13(Suppl 1):S12–20.CrossRef
91.
Grunkemeier DMS, Cassara JE, Dalton CB, Drossman DA. The narcotic bowel syndrome: clinical features, pathophysiology, and management. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2007;5(10):1126–39 quiz 1121–2.
92.
Johnston IN, Milligan ED, Wieseler-Frank J, Frank MG, Zapata V, Campisi J, et al. A role for proinflammatory cytokines and fractalkine in analgesia, tolerance, and subsequent pain facilitation induced by chronic intrathecal morphine. J Neurosci. 2004;24(33):7353–65.CrossRefPubMed
93.
94.
Crain SM, Shen KF. Opioids can evoke direct receptor-mediated excitatory effects on sensory neurons. Trends Pharmacol Sci. 1990;11(2):77–81.CrossRefPubMed
95.
Drossman D, Szigethy E. The narcotic bowel syndrome: a recent update. Am J Gastroenterol Suppl Print. 2014;2(1):22–30.CrossRef
96.
Drossman DA, Morris CB, Edwards H, Wrennall CE, Weinland SR, Aderoju AO, et al. Diagnosis, characterization, and 3-month outcome after detoxification of 39 patients with narcotic bowel syndrome. Am J Gastroenterol. 2012;107(9):1426–40.CrossRefPubMed
97.
Palsson OS, Whitehead WE. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2013;11(3):208–16.
98.
Bonaz BL, Bernstein CN. Brain-gut interactions in inflammatory bowel disease. Gastroenterology. 2013;144(1):36–49.CrossRefPubMed
99.
Sees KL, Delucchi KL, Masson C, Rosen A, Clark HW, Robillard H, et al. Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA. 2000;283(10):1303–10.CrossRefPubMed
Metadata
Title
Opioids and GI Motility—Friend or Foe?
Authors
Allen A. Lee, MD
William L. Hasler, MD
Publication date
01-12-2016
Publisher
Springer US
Published in
Current Treatment Options in Gastroenterology / Issue 4/2016
Print ISSN: 1092-8472
Electronic ISSN: 1534-309X
DOI
https://doi.org/10.1007/s11938-016-0112-0

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16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

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