Are Pain Meds Bad?

CrohnoPainPain is common among people with IBD. For many of us, it is the most debilitating symptom. Yet we are often told that pain medications will make us worse. Are pain meds really that bad?

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.

 

 

 

 

 

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2 thoughts on “Are Pain Meds Bad?

  1. I’ve had Severe Crohn’s Disease for over 30 years and for the first few years my gastroenterologist refused to help me with the “pain” because he said “narcotics slow down the peristalsis process.” As I’ve had a slow motility since I was 10 years old and wasn’t diagnosed with Crohn’s until I was 21, my body’s slow transportation of food through my bowels would happen with or without narcotics. In any event, after persistent yet unpredictable Intestinal Obstructions which often had me LAID OUT ON THE FLOOR OF DISGUSTING PUBLIC BATHROOMS hoping that a certain physical gesticulation would somehow ease the terrifying cramping pain, I found out about Pain Management doctors. Then once I began seeing a reputable Pain Management Physician, I was better able to manage my Crohn’s Disease because I didn’t have to go to the Emergency Room for every little Crohn’s flare-up which would abate anyhow in 48 hours. To that end, over the years I have developed a mutual trusting relationship with my Pain Management Physician and this has permitted me to live as normal a life as is reasonably possible given my aggressive Severe Crohn’s Disease which thus far has resulted in over 20+ surgeries, 200+ hospitalizations and life-threatening side effects to some of the most efficacious Crohn’s Disease medications. However, this requires me to be honest with myself about the severity of a flare-up such that I MUST go to an Emergency Room if my narcotics do not help with the pain. This can be very difficult to ascertain and then an even harder reality from which to capitulate since I am all too familiar with the necessary indignities of the hospital patient experience. However, that’s the way it has to be. Additionally, if it is extremely rare to get “Narcotic Bowel Syndrome” (NBS), I think it is INHUMANE for gastroenterologists to withhold information about the specialty of Pain Management as too many often do. For some Crohn’s Disease and Ulcerative Colitis patients, the pain is tolerable. But for other IBD patients who suffer through unpredictable Intestinal Obstructions and other incredibly painful IBD, utilizing narcotic pain medications under the supervision of a reputable Pain Management Physician can be a KEY treatment technique to one of the worst symptoms of IBD which can destroy the social and professional lives of any IBD patient. Finally, as I age I find that the peripheral manifestations of Crohn’s Disease are more common than the gastrointestinal effects. In that regard, my body’s inability to efficiently thwart inflammation due to my Crohn’s Disease makes these other health issues such as “Sacroiliitis” and MANY “Root Canal Dental Treatments” much more painful and these other medical/dental problems based on inflammation tend to affect me for a longer period of time than the normal patient without Crohn’s Disease. While I use Acupuncture and other non-narcotic pain-relieving modalities to help with the pain, if it weren’t for narcotic pain medications, at times, it would be too painful to get out of bed and/or to be at all productive.

    1. Yes , I agree with you. Pain meds do have a place and must be used if needed for Crohn’s debilitating pain. I too have many extra manifestations – joint pain, fistulas, abscess and use pain meds when needed. My colorectal surgeon is much more understanding then my GI and I get my pain meds from him.
      Stay well!
      Mark

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