By “pain meds”, I mean opiates and opioids: sometimes called ‘narcotic pain killers’. Opiates are natural chemicals from the poppy plant — the same plant that produces poppy seeds. Some popular prescription opiates include codeine and morphine.
Opioids are similar drugs made by synthetic means. Some popular prescription opioids include oxycodone (in Oxycontin and Percoset) and hydromorphone (in Dilaudid). Heroin is also a very popular opioid, but it is illegal most places.
People with inflammatory bowel disease are often told that narcotic pain meds are bad for them. This is due to a number of studies that show an association between narcotic pain meds and bad outcomes (like death). One study found narcotic use “to be associated with disease activity, disability, female gender, polypharmacy, smoking, and longer disease durations”.* The association leads many physicians to believe that pain meds are causing the bad outcomes.
A recent study in the Journal of Clinical Medical Research** tried to test the idea that pain meds do not cause people with IBD — specifically, Crohn’s — worse outcomes. The authors assumed instead that people with worse disease may be more likely to take pain meds.
The study surveyed 108 patients with Crohn’s disease, asking them about their disease, drug use, and other health factors. This method is far from perfect, but the results are nonetheless important. What the study found was that narcotics were associated with fistulas and smoking. From the study:
Both fistula and smoking have been previously associated with more severe CD, suggesting that the use of opiates in this population may be a response to disease severity rather than a cause of disease severity.
The authors caution that this is not evidence that patients with Crohn’s should be prescribed more narcotics. Rather, more research is required to determine whether opioid pain meds really do make IBD more severe. And there are still very real risks to narcotics, including addiction and other problems.
On a related note: among the risks of pain meds is something called “narcotic bowel syndrome” (NBS), in which abdominal pain worsens with continued narcotic use. Physicians often point to this as a reason to keep patients with IBD off pain meds, but it is very rare: a 2007 review study* found only four case reports, and another study found only 4% of narcotics users might have NBS.
Moreover, narcotic bowel syndrome is associated with heavy users of opioids, especially people who take more than 100 milligrams of morphine (or equivalent) per day. That translates to 6 high-dose (4mg) Dilaudid tablets a day. (That’s a lot of pain meds! Fun dosage calculator here.) And treating NBS is straightforward — not nearly as tricky as IBD.
Many of us with IBD have a hard time getting our physicians to take pain seriously. Too often, these physicians assume that studies which show an ‘association’ also show a cause. The information we get about pain meds is thus misleading, giving us the idea that pain meds will only make us worse off.
By understanding that pain meds might not hurt us, we can take an important step towards getting help with the pain of inflammatory bowel disease.
*The quote is from the below source, describing a different study.
**Cheung, M. et al. “Clincal Markers of Crohn’s Disease Severity and Their Association With Opiate Use.” Journal of Clinical Medicine Research, 7:1 (Jan 2015). Free online.
Photo of pain meds by author Duncan Cross. They didn’t make my disease any worse; in fact, they helped a lot and probably saved my life, although it turns out I don’t metabolize oral Dilaudid fully. Go figure.