Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration

Abstract

SummaryBackgroundWhile opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit.AimTo compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role.MethodsVeterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID. This cohort study examined VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during the year and number of prescriptions filled. Bivariate and multiple logistic regression analyses adjusted for potential confounding factors (demographics, medical diagnoses, social factors) and identified potential mediators (service use, psychiatric comorbidity) of opioid use in these groups.ResultsA greater proportion of veterans with FGID received an opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In multivariate logistic regression, personality disorders and drug abuse (OR 1.23 for each group), recent homelessness (OR 1.22), psychotropic medication fills (OR 1.55) and emergency department encounters (OR 1.21) were independently associated with opioid prescription use.ConclusionsDespite the potential for adverse consequences, opioids more often are prescribed for veterans with chronic, unexplained GI symptoms compared to those with structural diagnoses. Psychiatric comorbidities and frequent healthcare encounters mediate some of the opioid use risk.

Medication prescriptions in 322 motor functional neurological disorder patients in a large UK mental health service: A case control study

“…Of patients on medication, 31% in our study received at least one opioid analgesic, a rate similar to reports in fibromyalgia (Fitzcharles et al, 2011) and unexplained gastrointestinal symptoms (Sayuk et al, 2018). Like our antidepressant results, it is difficult to ascertain whether patients are prescribed these drugs to treat comorbidities, to treat mFND directly or to alleviate secondary pain arising from motor symptoms, like pain due to spasms, cramps and stiffness.…”

“…Opioid prescriptions varied between 28 and 36% in patients with unexplained gastrointestinal symptoms, fibromyalgia, and chronic fatigue (Sayuk et al, 2018, Fitzcharles et al, 2011, Vercoulen et al, 1996 and higher rates of benzodiazepines, gastric reflux medications, inhalers and blood pressure medications have been reported in PNES compared to epilepsy patients (Gazzola et al, 2012, Hantke et al, 2007. Patients with functional symptoms in primary care have been reported to have higher rates of both psychotropic and somatic medications compared to controls (olde Hartman et al, 2004).…”

Impact of Opioid Consumption in Patients With Functional Gastrointestinal Disorders

“…In our study, rheumatologic, neurologic comorbidities and migraine were strongly associated with opioid use, confirming that opioids in FGID patients are primarily prescribed for associated conditions. Despite their side effects, opioids are more commonly prescribed to patients with FGID than patients with identified organic gastrointestinal diseases (Sayuk et al, 2018). In addition, opioid misuse was associated with FGID in a cohort of inflammatory bowel disorders (Crocker et al, 2014;Sayuk et al, 2018).…”

Gut‐focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence‐base, practical aspects, and the Manchester Protocol

“…It is estimated that around a quarter of patients have severe, refractory symptoms, with significant impairment of quality of life (QoL), detrimental effects on daily functioning, personal and social relationships, workplace productivity, and psychological well‐being including suicidal ideation . These patients are also vulnerable to iatrogenic harm including repeatedly negative investigations, opiate analgesia, and unnecessary surgical interventions, not to mention the associated spiraling healthcare costs . Perhaps unsurprisingly, when we consider the current pathophysiological understanding of FGIDs, among all the heterogeneous treatment options available, approaches targeting 'gut‐brain interactions' including centrally acting neuromodulators and behavioral approaches such as gut‐focused hypnotherapy have shown the most promise.…”