Table 1.

Diagnostic Criteria for Narcotic Bowel Syndrome

Chronic or frequently recurring abdominal pain that is treated with acute high dose or chronic narcotics and all of the following:

The pain worsens or incompletely resolves with continued or escalating dosages of narcotics.

There is marked worsening of pain when the narcotic dose wanes and improvement when narcotics are reinstituted (“Soar and Crash”).

There is a progression of the frequency, duration and intensity of pain episodes.

The nature and intensity of the pain is not explained by a current or previous gastrointestinal diagnosis*

^*A patient may have a structural diagnosis (e.g., inflammatory bowel disease, “chronic pancreatitis”) but the character or activity of the disease process is not sufficient to explain the pain.