Korean J Pain.  2019 Apr;32(2):69-78. 10.3344/kjp.2019.32.2.69.

Opioid-induced constipation: a narrative review of therapeutic options in clinical management

• Lang-Illievich K
• Bornemann-Cimenti H

• KMID: 2449819
• DOI: http://doi.org/10.3344/kjp.2019.32.2.69

Abstract

Pain therapy often entails gastrointestinal adverse events. While opioids are effective drugs for pain relief, the incidence of opioid-induced constipation (OIC) varies greatly from 15% to as high as 81%. This can lead to a significant impairment in quality of life, often resulting in discontinuation of opioid therapy. In this regard, a good doctor-patient relationship is especially pivotal when initiating opioid therapy. In addition to a detailed history of bowel habits, patient education regarding the possible gastrointestinal side effects of the drugs is crucial. In addition, the bowel function must be regularly evaluated for the entire duration of treatment with opioids. Furthermore, if the patient has preexisting constipation that is well under control, continuation of that treatment is important. In the absence of such history, general recommendations should include sufficient fluid intake, physical activity, and regular intake of dietary fiber. In patients of OIC with ongoing opioid therapy, the necessity of opioid use should be critically reevaluated in terms of an with acceptable quality of life, particularly in cases of non-cancer pain. If opioids must be continued, lowering the dose may help, as well as changing the type of opioid. If these measures do not suffice, the next step for persistent OIC is the administration of laxatives. If these are ineffective as well, treatment with peripherally active μ-opioid receptor antagonists should be considered. Enemas and irrigation are emergency measures, often used as a last resort.

Keyword

Constipation; Dietary fiber; Enema; Exercise; Habits; Incidence; Laxatives; Narcotic antagonists; Opioid analgesics; Pain management; Pharmaceutical preparations; Quality of life

MeSH Terms

Analgesics, Opioid
Constipation*
Dietary Fiber
Emergencies
Enema
Health Resorts
Humans
Incidence
Laxatives
Motor Activity
Narcotic Antagonists
Pain Management
Patient Education as Topic
Pharmaceutical Preparations
Quality of Life
Analgesics, Opioid
Laxatives
Narcotic Antagonists
Pharmaceutical Preparations

Figure

• 

  Fig. 1 Clinical management of opioid induced constipation. PAMORAs: peripherally active μ-opioid receptor antagonists.

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