Pharmacological Challenges in Short Gut Syndrome and Pain Management: A Case Series and Review of Literature.

Short gut syndrome presents multiple unique challenges in pain management and orally delivered medications. The removal or reduction of gastrointestinal sites of absorption, high-output states, and inability to absorb oral medications often limit pain management strategies. We report our experiences caring for individuals with short gut syndrome and share the challenges and strategies we have utilized to optimize pain control for our patients. Case 1 describes a 49-year-old male with an extensive history of abdominal surgery leading to chronic abdominal pain requiring alternative routes of administration and utilization of unique pharmacology considerations to optimize oral absorption and pain control. Case 2 describes a 68-year-old female with cancer-related pain, which required high opioid requirements and utilization of opioids with unique mechanisms of action for complex pain syndromes. We will include potential management strategies described in the cases and conclude with pharmacokinetic considerations for various drug therapy options in pain management.