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PAINSCAN LITERATURE REVIEW
Issue 1, Volume 6
Opioid-Induced Constipation: Treatment Modalities
5 Articles in this Series
Introduction
Opioid Induced Constipation: A Book/Primer
A Review of Health-related Quality of Life, Patient Burden, Practical Clinical Considerations, and the Impact of Peripherally Acting μ-Opioid Receptor Antagonists
Systematic review with meta-analysis: efficacy and safety of treatments for opioid-induced constipation
Peripheral Opioid Receptor Antagonists for Opioid-Induced Constipation: A Primer on Pharmacokinetic Variabilities with a Focus on Drug Interactions
The Use of Peripheral μ-Opioid Receptor Antagonists (PAMORA) in the Management of Opioid-Induced Constipation: An Update on Their Efficacy and Safety

Introduction

Opioids are widely used for moderate to severe pain and are often the last-line treatment in those who have failed non-opioid alternatives.  The number of opioid prescriptions increased from the 1990s until about 2011-2012, reaching a maximum of over 255 million opioid prescriptions in 2012.1,2

While beneficial for pain, opioids can have negative side effects, especially on the gastrointestinal (GI) system.  The most common and troublesome side effect for patients is opioid-induced constipation (OIC).3-6  The prevalence of OIC is high among those on chronic opioid therapy, ranging between 41 and 81%.7-10

PAMORAs indicated for treating OIC in patients with non-cancer pain include methylnaltrexone bromide, naldemine, naloxogel. (Image: iStock)

OIC can become so severe that some patients must temporarily or permanently cease using opioids – sacrificing the beneficial effects on analgesia – in order to facilitate normal bowel movements, and negatively affecting patient’s perceived quality of life.11,12 What is more, OIC is often not recognized by clinicians and un- or under-reported by patients, acting as a barrier to recognition and treatment.13-15

There exist multiple tools such as the Rome IV criteria and Bristol Stool Scale which have been developed to help aid in the recognition and diagnosis of functional gastrointestinal disorders, including OIC. 

Moreover, there are various treatment options for OIC including lifestyle changes, laxatives, and peripherally acting mu opioid receptor antagonists (PAMORAs).  Nevertheless, OIC occurs via a complex process, and each of these treatment modalities has its limitations. 

In the following PainScan, we review five recently published papers that discuss current knowledge and thinking around opioid-induced constipation and its pathophysiology, as well as the treatment modalities available and what data show regarding their limitations. 

Included in the review:

  • Argoff CE. Opioid-induced Constipation: A Review of Health-related Quality of Life, Patient Burden, Practical Clinical Considerations...
  • Gudin J, Fudin J. Peripheral Opioid Receptor Antagonists for Opioid-Induced Constipation...
  • Pergolizzi JV et al, The Use of Peripheral μ-Opioid Receptor Antagonists (PAMORA) in the Management of Opioid-Induced Constipation...
  • Sizar O et al, Opioid Induced Constipation...
  • Vijayvargiya P et al, Systematic review with meta-analysis: efficacy and safety of treatments...
First Article:
Opioid Induced Constipation: A Book/Primer
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