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Opioid-induced constipation: advances and clinical guidance.

ABSTRACT: Currently opioids are the most frequently used medications for chronic noncancer pain. Opioid-induced constipation is the most common adverse effect associated with prolonged use of opioids, having a major impact on quality of life. There is an increasing need to treat opioid-induced constipation. With the recent approval of medications for the treatment of opioid-induced constipation, there are several therapeutic approaches. This review addresses the clinical presentation and diagnosis of opioid-induced constipation, barriers to its diagnosis, effects of opioids in the gastrointestinal tract, differential tolerance to opiates in different gastrointestinal organs, medications approved and in development for the treatment of opioid-induced constipation, and a proposed clinical management algorithm for treating opioid-induced constipation in patients with noncancer pain.

SUBMITTER: Nelson AD

PROVIDER: S-EPMC4772344 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Opioid-induced constipation: advances and clinical guidance.

Nelson Alfred D AD Camilleri Michael M

Therapeutic advances in chronic disease 20160125 2

Currently opioids are the most frequently used medications for chronic noncancer pain. Opioid-induced constipation is the most common adverse effect associated with prolonged use of opioids, having a major impact on quality of life. There is an increasing need to treat opioid-induced constipation. With the recent approval of medications for the treatment of opioid-induced constipation, there are several therapeutic approaches. This review addresses the clinical presentation and diagnosis of opio ...[more]

PMID: 26977281

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Project description:BACKGROUND:Little is known regarding the burden of opioid-induced constipation (OIC) among patients who suffer from cancer-related pain. METHODS:A prospective longitudinal study was conducted among cancer patients in the United Kingdom (UK), Canada, and Germany, which included medical record data abstraction, Internet-based patient surveys, and physician surveys. Patients on daily opioid therapy (?30?mg for ?4?weeks) for treatment of cancer pain with self-reported OIC were recruited. Response to laxatives was defined by classifying participants into categories of laxative use and evaluating the prevalence of inadequate response. Descriptive statistics were used to evaluate outcomes, including the patient assessment of constipation-symptom (PAC-SYM), patient assessment of constipation-quality of life, EuroQOL-5 dimensions, and global assessment of treatment benefit, satisfaction, and willingness to continue. RESULTS:Recruitment was difficult for this study with only 31 participants completing the baseline survey and meeting criteria for opioid use and OIC (26 UK, 1 Canada, and 4 Germany). Fifty-two percent (n?=?16) of participants were male, and all were White. Breast (23%, n?=?7), pancreatic (13%, n?=?4), and multiple myeloma (13%, n?=?4) were the most common cancers. Mean duration of chronic pain and opioid use were 2.3 and 1.3?years, respectively. Participants reported having a mean of 4.4 bowel movements/week in the 2?weeks prior to baseline, of which a mean of 0.9 were spontaneous. Most participants (90%, n?=?28) were using at least 1 lifestyle approach to manage their constipation; 65% (n?=?20) were taking ?1 over-the-counter laxative; 19% (n?=?6) were taking ?1 prescription laxative; 23% (n?=?7) reported no laxative use in the prior 2?weeks. Moderate-to-severe constipation symptoms on the PAC-SYM were common, and mean scores on health-related quality of life outcomes were comparable to chronic pain populations. CONCLUSION:In this primarily UK sample, there appears to be considerable unmet OIC treatment needs among cancer patients.

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Opioid-induced constipation: advances and clinical guidance.

Publications

Opioid-induced constipation: advances and clinical guidance.

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