Dealing with Opioid-Induced Constipation? Try an Osteopathic Approach

Constipation is one of many undesirable side effects of long-term opioid usage. Here’s how patients managing their chronic pain with opioids can find some relief.

If you’re treating your chronic pain with opioids, you may have experienced constipation. Characterized by difficult and infrequent emptying of the bowels (generally fewer than three times a week), constipation can add discomfort and inconvenience to your chronic pain symptoms. Constipation affects between 40% and 80% of patients using opioids to manage pain, making it a very common problem.1-3


Traditional Medications

Traditional remedies include over-the-counter stool softeners and laxatives, as well as changes to diet. These treatments are convenient, inexpensive, and generally safe, but they may not be that effective in relieving opioid-induced constipation.4,5 Constipation caused by opioids has a different pathophysiology—that is, what’s going on in your body at the cellular level—than that of traditional constipation (which typically has a physical cause such as diet, lifestyle, or a blockage) or functional constipation (which has no known cause). Unfortunately, even prescription medications specifically designed to combat constipation caused by opioids can result in undesirable side effects, such as nausea, vomiting, and dizziness.6

An Osteopathic Approach

The good news is that osteopathic medicine may offer a solution. “Osteopathy is a philosophy that looks at the whole person: mind, body, and spirit,” says David Shoup, DO, and associate professor at AT Still University of Health Sciences in Mesa, Arizona. Osteopathic doctors are licensed physicians with expertise in osteopathic manipulative treatment (OMT), a hands-on technique that focuses on the neuromusculoskeletal system (nerves, muscles, and bones). DOs often use OMT to diagnose injury and illness, help relieve pain, and promote healing.

Osteopathic doctors may use pressure, stretches, and resistance exercises to gently manipulate the muscles and tissues associated with nerves responsible for various processes. “We’re looking for areas of soft tissue restriction, muscle spasm, or hypertonicity (muscle tightness),” Dr. Shoup explains. For a patient with opioid-induced constipation, Dr. Shoup might first “palpate the spine and lower back,” for example, where nerves that send signals to the colon and small intestine are located.

“Generalized back pain often accompanies constipation,” Dr. Shoup notes, but even if constipated patients don’t have back pain, “we will often find tight and restricted areas.” Dr. Shoup would then apply pressure or use resistance exercises to relax muscles and tissues around the area, which should help ease constipation. And, as Shoup points out, “If the patient is on opioids due to chronic pain, osteopathic treatment can help reduce the pain, which will, in turn, help reduce the opioid use.”

An osteopathic doctor may also use OMT on the abdomen, home of the nerve tissue responsible for gut motility (the movement of the digestive system, including elimination). Another approach may involve hands-on stretching of the diaphragm, which is located beneath the lungs. Dr. Shoup explains that this type of stretching can help improve blood flow and lymph drainage (the clear fluid that surrounds cells and tissues), which can help to improve overall gastrointestinal functioning.

Treatment Timetable

“Typically, treatment includes a physical exam, history, then manipulation to help the body heal itself,” Dr. Shoup says. Osteopathic manipulation usually lasts 20 to 30 minutes. A doctor may  recommend additional steps you can take at home to continue battling the constipation. These methods may include increasing intake of water and fiber-rich foods, and possibly adding a magnesium supplement, which, at high doses, can have laxative effects.7 Dr. Shoup also encourages patients to exercise. “When you exercise, you’re speeding up your metabolism and getting things moving. Once you stop, you’ve facilitated motion through the body, including the colon. Exercise has some benefit for just about any medical problem.”

After the first osteopathic manipulation appointment, patients usually return the following week, where they’ll often report significant improvement (for instance, going from two or three to four or five bowel movements a week) within two to four weeks. If at-home exercises and techniques are performed correctly, “the patient may not need to come in for treatment—once or twice a week at home might be enough to improve their symptoms.” For patients on opioids long-term, a monthly visit should help patients maintain improved bowel function, although the problem may not completely resolve, Dr. Shoup notes.

Updated on: 02/07/18