Rome IV Diagnostic Criteria for Narcotic Bowel Syndrome
Official Rome IV criteria for the diagnosis of narcotic bowel syndrome.
Use in patients with onset or increase of chronic abdominal pain treated with narcotics in which the pain worsens or does not resolve.
Patients with any of the following features must be evaluated clinically for other diagnoses even though narcotic bowel syndrome may be present:
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Signs or symptoms of gastrointestinal bleeding.
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Unexplained iron deficiency anemia.
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Unintentional weight loss.
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Palpable abdominal mass or lymphadenopathy on exam.
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Family history of GI cancer.
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Onset of symptoms age ≥50 years and have not had age-appropriate colon cancer screening.
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Sudden or acute onset of new change in bowel habit.
If diagnosis not met (negative):
Current symptoms are unlikely to be caused by narcotic bowel syndrome. Consider further assessment as clinically indicated.
If meets diagnosis (positive):
Likely diagnosis of narcotic bowel syndrome. Consider initiating treatment.
The choice of therapies is outside the scope of this calculator and will depend on clinical context.
Establishing an effective patient provider relationship is critical for the management of narcotic bowel syndrome. Initiating non-opiate pain management strategies (e.g., neuromodulators and behavioral treatments) prior to narcotic withdrawal is an important step. Working with other providers and/or programs to aid in supervised detoxification should be considered.
This calculator should only be used in patients who do not have signs or symptoms suggestive of a structural/mechanical, metabolic or systemic cause of their symptoms based on clinical history, physical exam and initial work-up.