Dear IHH -

I don't know if you are using narcotics for your pain, but if so, please read on.

My pain mgt. doctor is collaborating with another colleague at his institution, in which they have tentitively shown, in a "proto-study", that the long-term use of opioids can trigger a bacterial bloom in the small intestine, which in turn creates neuro-toxins. I know that as soon as gas spectrometry found elevated level of hydrogen in my breath, I was given a serious round of a major GI antibiotic (Xifaxan) and the cramping went away!

Now, a week after the antibiotic trial ended the cramping came back. Since then I have had probably 4 or 5 rounds of the antibiotic, and while each has helped, it hasn't been as spectacular as the first round.

I do, however, do a few things, and please bear with me when I mention drugs. First, I've been given the generic version of Narcan, an old drug which - when given iv or im - immediately shuts down opioid receptors throughout the body for people who are overdosing, sometimes with violent results. However, I'm being given it orally, just to shut down the opioid receptors in my gut, every time I take any ocycodone/oxcycontin, and I don't feel a thing. Secondly, I'm being given truly infant sized doses of the antibiotic Erythromycin to speed up the movement of material through the gut, the very action that the narcotics suppress. I also use a good over the counter "natural laxative" called Senokot-S.

While the GI effects of narcotics have been known for many years, it is my understanding that no published research (to date) precisely supports this treatment at the present time, yet it works. And while I suspect that even the Senokot-S, standing alone could make some difference, I wouldn’t bet on it. Then again, I also use Zanaflex, Neurontin and Baclofen, and while I know you said "no drugs," I have to tell you that I have no idea how I would manage without them. (By example, a couple of years ago I had to go off of what was for me Neurontin's predecessor -Trileptal - without the opportunity to taper off gradually as I ramped up with another medication, because I had developed a dangerous side effect, and 10 days later I was having scalp cramps. You haven't lived until you've had a good scalp cramp, believe me.)

I hope this has been helpful, even though I know it's not exactly what you were asking about.

Mike