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Review Article

Korean J Pain 2019; 32(2): 69-78

Published online April 1, 2019 https://doi.org/10.3344/kjp.2019.32.2.69

Copyright © The Korean Pain Society.

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

Kordula Lang-Illievich and Helmar Bornemann-Cimenti

Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria

Correspondence to:Helmar Bornemann-Cimenti
Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
Tel: +43-316-385-81103, Fax: +43-316-385-13852, E-mail: helmar.bornemann@medunigraz.at
ORCID: https://orcid.org/0000-0002-1201-3752

Received: August 24, 2018; Revised: January 2, 2019; Accepted: January 14, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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