Figure 1.

Vicious cycle of patient-physician interaction in narcotic bowel syndrome. Patient presents with a pain, either due to a structural condition (e.g., IBD), post-surgery or functional GI disorder and narcotics are started. Patient develops symptom of Narcotic Bowel Syndrome. Subsequent evaluation is unrevealing and the narcotics are escalated to treat the abdominal pain with worsening of NBS. This prompts the patient to increase health care utilization or make emergency room visits, which leads to physician frustration and “furor medicusw” leading to a maladaptive therapeutic interaction with additional use of narcotics. The cycle continues until the syndrome is recognized and treatment initiated.