For 2 years, 39 patients seen by the GI consult service at the University of North Carolina at Chapel Hill (UNC) with presumed NBS were placed on a detoxification program. Clinical, psychosocial, health status, and outcome data were obtained before and after detoxification. Our aims were to: (i) clinically characterize patients with presumed NBS, (ii) assess the clinical response and adverse effects to detoxification, (iii) identify clinical and psychosocial predictors of treatment response, and (iv) determine the clinical outcome at 3 months after detoxification and the time frame for patients who revert back to
narcotics.
RESULTS: Of the 39 patients detoxified, 89.7% met predefined criteria. Patients were mostly well educated (14.5 ± 2.3 years of school), female (92.3%), and with a variety of diagnoses (21%
irritable bowel syndrome IBS/functional, 37%
inflammatory bowel disease and other structural, 29%
fibromyalgia and other functional somatic, or orthopedic, and 13% postoperative or other). They reported high health-care use (15.3 ± 10.1 MD visits/6 months; 6.5 ± 6.1 hospitalizations/2 years, 6.4 ± 2.0 surgeries/lifetime), and 82.1% were jobless. Despite high dosages of
narcotics (total intravenous (IV)
morphine equivalent 75.3 ± 78.0 mg/day),
pain scores were rated severe (52.9 ± 28.8 visual analog scale (VAS); 257.1 ± 139.6 functional bowel disorder severity index (FBDSI); 17.2 ± 10.2 (McGill
Pain and greater than labor or
postoperative pain). Multiple symptoms were reported (n = 17.8 ± 9.2) and rated as moderate to severe. Psychosocial scores showed high catastrophizing (19.9 ± 8.6); poor daily function (Short Form-36 (SF-36) physical 28.3 ± 7.7, mental 34.3 ± 11.0; worse than
tetraplegia); 28.2% were clinically depressed and 33.3% anxious (Hospital Anxiety and Depression Scale (
HADS)). Detoxification was successfully completed by 89.7%; after detoxification,
abdominal pain was reduced by 35% (P < 0.03) and nonabdominal
pain by 42% (P < 0.01) on VAS, and catastrophizing significantly improved (P < 0.01). Responder status was met in 56.4% with 48.7% achieving a ≥ 30% reduction in
pain. By 3 months after detoxification, 45.8% had returned to using
narcotics. For those who remained off
narcotics at 3 months, the VAS
abdominal pain score was 75% lower than pretreatment when compared with those who went back on
narcotics (24% lower). Successful detoxification and a good clinical response was associated with low abuse potential (Current
Opioid Misuse Measure (COMM) score < 9).
CONCLUSIONS: Despite severe
pain, poor coping, and poor health status, almost all patients with NBS undergoing detoxification were able to stop using
narcotics and have significant improvement in
pain and coping. However, almost ½ reverted to
narcotic use at 3 months. Those who stayed off
narcotics showed greater improvement in
pain scores. This study provides a rationale for treating patients with NBS by detoxification in order to improve their clinical status. Further work is needed to understand the reasons for the high recidivism rate.