PAIN MEDICATIONS: THEIR USE AND THEIR DANGERS

Unfortunately, many patients with inflammatory bowel disease (IBD) have abdominal pain. This can come with disease activity and the intestinal sores, complications, or after surgery. 

When the pain is mild, acetaminophen (Tylenol) and non-steroidal medications like ibuprofen (Motrin) and naproxen (Aleve, Naprosyn) can relieve the discomfort. But overuse of acetaminophen can damage the liver and the non-steroidal medications (NSAIDS) can cause ulcers and narrowed areas (strictures) that are similar to what we find in Crohn's disease. In fact, there are cases where these non-steroidal medicines have been thought to trigger Crohn's disease.

The bigger problems come when the pain is worse, which is quite understandable after surgery, for example. To control that pain, stronger medicine often is needed. Opioids, which used to be called narcotics, can provide effective relief in the beginning.

Opioid Medicines Have a Long List of Side Effects

• Tolerance—patients gradually outgrow their dose and need more and more to control their pain
• Withdrawal when the medicine wears off, causing more pain, nausea, diarrhea and anxiety
• Constipation, bloating and the bowel not working as well 
• Can mask a flare so that symptoms and the bowel gets worse
• Overdose can result in death

These likely can result in more emergency room visits, more medicines and increased hospitalizations. In fact, a recent study (N Burr Clin Gastroenterology Hepatology, 2017) found that patients had 2 to 3 times more risk of dying if they had been prescribed a strong narcotic / opioid more than 3 times in a year for Crohn's disease or ulcerative colitis. In part, that can be due to the fact that they are used for sicker patients, but it may be that the side effects themselves can kill patients.