Opiate-induced gastrointestinal hyperalgesia can be diagnosed using the Rome IV criteria. Abdominal pain continues or gets worse with increasing dosages of opioids.
Criteria for opiate-induced gastrointestinal hyperalgesia:
(1) chronic or frequently recurring abdominal pain (occurs most days) which has been treated with acute high-dose or chronic narcotics
(2) no current or previous diagnosis explains the pain
(3) at least 2 of the following:
(3a) pain worsens or incompletely resolves with continued or escalating doses of narcotics
(3b) "soar and crash" (pain worsens as narcotic dose decreases and improves when narcotics restarted
(3c) there is progression in frequency, duration and intensity of pain episodes
where:
• The patient may have an intra-abdominal diagnosis (such as pancreatitis) but this cannot explain the pain.
Temporal criteria:
(1) >= 6 months since onset of symptoms
(2) criteria should be fulfilled in the 3 months prior to diagnosis
The patient will show significant improvement in pain after the opioids are withdrawn.
