TY - JOUR
T1 - Pathophysiology, diagnosis, and management of opioid-induced constipation
AU - Farmer, Adam D.
AU - Holt, Caroline Bruckner
AU - Downes, Thomas J.
AU - Ruggeri, Eugenio
AU - Del Vecchio, Sara
AU - De Giorgio, Roberto
PY - 2018
Y1 - 2018
N2 - Opioids are potent analgesics used for the treatment of acute and chronic pain. Side-effects are common and among the most bothersome are those associated with opioid-induced bowel dysfunction, which includes opioid-induced constipation. In this Review, we provide a summary of the pathophysiology, diagnosis, and management of opioid-induced constipation, which can be defined as a change in baseline bowel habit or defecatory patterns following initiation, alteration, or increase of opioid therapy. Opioid-induced constipation is a consequence of the action of opioids on their receptors in the gastrointestinal tract. A comprehensive clinical assessment is beneficial, including evaluation of the patient's understanding of their constipation and underlying condition for which opioids are used. Clinical assessment should also aim to differentiate opioid-induced constipation from pre-existing constipation exacerbated by the opioids. Preventive strategies need to be considered when patients start treatment with opioids, such as lifestyle changes. First-line management includes simple over-the-counter laxatives. The bowel function index can be useful to objectively identify patients who are refractory to these initial measures. In this context, alternative over-the-counter laxatives (or combinations of laxatives), secretogogues, or peripherally acting μ-opioid receptor antagonists might also be considered. Educational strategies need to be developed to improve the knowledge base of health-care providers on the identification and management of opioid-induced constipation.
AB - Opioids are potent analgesics used for the treatment of acute and chronic pain. Side-effects are common and among the most bothersome are those associated with opioid-induced bowel dysfunction, which includes opioid-induced constipation. In this Review, we provide a summary of the pathophysiology, diagnosis, and management of opioid-induced constipation, which can be defined as a change in baseline bowel habit or defecatory patterns following initiation, alteration, or increase of opioid therapy. Opioid-induced constipation is a consequence of the action of opioids on their receptors in the gastrointestinal tract. A comprehensive clinical assessment is beneficial, including evaluation of the patient's understanding of their constipation and underlying condition for which opioids are used. Clinical assessment should also aim to differentiate opioid-induced constipation from pre-existing constipation exacerbated by the opioids. Preventive strategies need to be considered when patients start treatment with opioids, such as lifestyle changes. First-line management includes simple over-the-counter laxatives. The bowel function index can be useful to objectively identify patients who are refractory to these initial measures. In this context, alternative over-the-counter laxatives (or combinations of laxatives), secretogogues, or peripherally acting μ-opioid receptor antagonists might also be considered. Educational strategies need to be developed to improve the knowledge base of health-care providers on the identification and management of opioid-induced constipation.
UR - http://www.scopus.com/inward/record.url?scp=85042357195&partnerID=8YFLogxK
U2 - 10.1016/S2468-1253(18)30008-6
DO - 10.1016/S2468-1253(18)30008-6
M3 - Review article
SN - 2468-1253
VL - 3
SP - 203
EP - 212
JO - The Lancet Gastroenterology & Hepatology
JF - The Lancet Gastroenterology & Hepatology
IS - 3
ER -