Opioids were one of the earliest classes of medications used for pain across a variety of conditions, but morbidity and mortality have been increasingly associated with their chronic use. Despite these negative consequences, chronic opioid use is increasing worldwide, with the USA and Canada having the highest rates. Chronic opioid use for noncancer pain can have particularly negative effects in the gastrointestinal and central nervous systems, including opioid-induced constipation, narcotic bowel syndrome, worsening psychopathology and addiction. This Review summarizes the evidence of opioid misuse in gastroenterology, including the lack of evidence of a benefit from these drugs, as well as the risk of harm and negative consequences of opioid use relative to the brain–gut axis. Guidelines for opioid management and alternative pharmacological and nonpharmacological strategies for pain management in patients with gastrointestinal disorders are also discussed. As chronic pain is complex and involves emotional and social factors, a multimodal approach targeting both pain intensity and quality of life is best.

阿片类药物是最早用于治疗多种病症的疼痛的药物之一，但发病率和死亡率越来越与其长期使用相关。尽管存在这些负面影响，全球范围内慢性阿片类药物的使用仍在增加，其中美国和加拿大的使用率最高。长期使用阿片类药物治疗非癌性疼痛会对胃肠道和中枢神经系统产生特别负面的影响，包括阿片类药物引起的便秘、麻醉性肠综合征、精神病理学恶化和成瘾。本综述总结了胃肠病学中阿片类药物滥用的证据，包括缺乏这些药物有益的证据，以及阿片类药物使用相对于脑肠轴的伤害风险和负面后果。还讨论了阿片类药物管理指南以及胃肠道疾病患者疼痛管理的替代药物和非药物策略。由于慢性疼痛很复杂，涉及情感和社会因素，因此针对疼痛强度和生活质量的多模式方法是最好的。