Opioid use ill-advised for US veterans with functional GI pain, finds study

There are various reasons for the uncontrolled spread of opioid epidemic, while doctors are to be blamed for freely prescribing these addictive medicines without realizing its long-term impact there are many patients who coerced their physicians to write these drugs by wrongly describing their problem or through doctor-shopping. For example, considered an easy option for pain relief, opioids are often prescribed to many war veterans dealing with unexplained chronic gastrointestinal (GI) pain, such as irritable bowel syndrome.

With an increase in the number of prescriptions comes a higher risk of the adverse effects of opioids on the health of these veterans. A new study published in the Alimentary Pharmacology and Therapeutics in January 2018, has revealed the different outcomes of opioid use among U.S. veterans with structural GI diagnoses (SGID), and those with unexplained GI symptoms or functional GI diagnoses (FGID).

According to the study, chances of opioid prescription were 40 percent higher in individuals with a functional disorder, as compared to SGID. The percentage of Veterans Health Administration (VHA) diagnosed with FGID getting an opioid prescription during a period of one year was quite high.

Patients in functional group at higher risk

To conduct the study, a team of researchers examined the clinical data of 272,431 veterans with FGID and compared it with that of 1,223,744 patients with GI disorders having a structural component. The administrative data from 2012 was collected from the VHA, while details regarding prescription drugs were obtained from the Department of Veterans Affairs Drug Benefit Management database.

Based on their study, the researchers came to the following conclusions:

At least one opioid prescription was received by approximately 36 percent of the functional GI group in 2012. The percentage was lower (28.9 percent) in the structural diagnosis group.
The average number of opioid prescriptions in the functional group during the one year study period was 7.1 as compared to 6.7 in the structural group.
Homelessness was found to be higher in the veterans with the unexplained GI symptoms, or FGID. They were also found to have a greater likelihood to have served in Iraq.
Patients in functional group were more likely to have dementia, seizures and HIV as compared to SGID patients. They were also more likely to be diagnosed with personality disorders, history of traumatic abuse and inpatient treatment for mental illnesses.
The use of psychotropic medications to treat fibromyalgia and somatic pain disorders was also high among patients in functional group.

SGID patients more likely to get opioids

Gregory Sayuk, M.D., of Washington University in St. Louis, and his colleagues are of the opinion that the possibility of a prescription for opioid medication was 40 percent higher for patients with functional disorders, like irritable bowels.

“Even with short-term use, ‘opioid bowel dysfunction’ manifested by nausea and vomiting, bloating/distention and constipation are common, making opioids an ill-advised, if not contraindicated, pain management option in patients with GI symptoms and especially functional symptoms,” noted the authors.

Road to recovery

Over the years, the number of opioid prescriptions have rose significantly, specifically among VA patients. It spiraled from 18.9 percent in 2004 to 33.4 percent by 2012. Precaution is expected on part of both the patients and the doctors when it comes to opioid prescriptions for patients with functional GI disorders as ingestion of painkillers can lead to hyperalgesia and worsen the symptoms of irritable bowel syndrome. Some patients also exhibit certain psychiatric disorders.

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