I had never heard this specific diagnosis bandied about in an Emergency Medicine context – but, essentially, it’s a gastroenterology entity (and diagnosis of exclusion) that entails, essentially, chronic, intractable, crampy abdominal pain of unknown etiology and concurrent narcotic use. I can’t even describe how many of these patients I saw each shift during residency – and how many of those people had multiple CT scans in the past year. The key feature in this particular diagnosis, as described in their case, is they had extensive follow-up evaluation, were weaned from their narcotics, and had resolution of symptoms.
I think this is a diagnosis spectrum we see a lot in the ED – whether it be constipation, IBS, cyclic vomiting syndrome, “feeling sick”, or the multitudinous abdominal pain of unknown etiology. With more and more patients being prescribed (or secretly taking) narcotics, what we see in our EDs is not just the overdose emergencies, but the various side effect spectrums of dependence and withdrawal.
You’d think that with all our medical technological prowess we’d have better mechanisms to treat pain than they did thousands of years ago.
“Narcotic Bowel Syndrome”
http://www.ncbi.nlm.nih.gov/pubmed/21719232