Irritable bowel syndrome (IBS) is a common chronic disorder seen in gastroenterology and primary care practice. It is characterized by recurrent abdominal pain or discomfort associated with disturbed bowel function. It is a heterogeneous disorder with varying treatments, and in this regard physicians sometimes struggle with finding the optimal approach to management of patients with IBS. This disorder induces high health care costs and variably reduces health-related quality of life. IBS is in the class of functional gastrointestinal disorders, and results from dysregulation of central and enteric nervous system interactions. Psychosocial factors are closely related to their gut physiology, associated cognitions, symptom manifestations and illness behavior. Therefore, it is important for the physician to recognize the psychosocial issues of patients with IBS and in addition to build a good patient-physician relationship in order to optimize treatment. This review focuses on the interaction between psychological and physiological factors associated with IBS by using a biopsychosocial model. In this article, we describe (1) the predisposing psychological features seen in early life; (2) the psychological factors associated with life stress, the symptom presentation, and their associated coping patterns; (3) gut pathophysiology with emphasis on disturbances in motility, visceral hypersensitivity and brain-gut interactions; and finally (4) the clinical outcomes and effective treatments including psychotherapeutic methods.

Biopsychosocial Model of Irritable Bowel Syndrome

Surveys indicate that clinicians are frequently ill equipped to treat cancer pain. Pain is often poorly assessed, and many caregivers lack sufficient knowledge to optimize treatment. Effective management requires an understanding of pain pathophysiology, the ability to identify and evaluate pain syndromes, and familiarity with proven therapeutic strategies. Opioid pharmacotherapy is the mainstay of treatment. Practical aspects of opioid therapy include selection of both drug and route, dose titration, and management of side effects. Specific strategies for the management of patients who are unable to attain an acceptable balance between pain relief and side effects include both noninvasive interventions (such as adjuvant analgesics, psychological therapies, and physiatric techniques) and invasive interventions (such as the use of intraspinal opioids, neural blockade, and neuroablative therapies). Sedation is an option at the end of life for the treatment of pain that is refractory to other interventions. These approaches can provide adequate relief to the vast majority of patients, most of whom will respond to systemic pharmacotherapy alone. Patients with refractory pain should have access to specialists in pain management or palliative medicine.

The management of cancer pain

https://www.cghjournal.org/article/S1542-3565(07)00629-5/pdf

The Narcotic Bowel Syndrome: Clinical Features, Pathophysiology, and Management

This article reviews the pharmacology and physiology of opiate receptors and the current and potential uses of opioid agonists and antagonists in clinical gastroenterology. Mu-receptors are involved in motor and sensory functions, and their modulation is established for treatment of diarrhea. Mu-antagonists have potential to reverse endogenous (e.g., postoperative ileus) or iatrogenic dysmotility (e.g., opioid bowel dysfunction). Modulation of the function of kappa-receptors may be a novel approach to control visceral pain in functional gut disorders. Results of formal testing of novel opioid modulators are keenly awaited.

Opioids and the gut: pharmacology and current clinical experience

https://www.gastrojournal.org/article/S0016-5085(02)15981-6/pdf

Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe irritable bowel syndrome.

In this editorial, we review the narcotic bowel syndrome, its etiology, presentation, and treatment. We suggest this is an often overlooked diagnosis in many clinical settings.

Rogers M

Papers

The narcotic bowel syndrome.