Although opioids offer potent analgesia for severe acute and chronic noncancer pain, adverse gastrointestinal effects potentially\nundermine their clinical utility. In particular, between 40% and 95% of patients develop opioid-induced constipation (OIC). Therefore,\nthere is a consensus that patients should commence laxatives at the start of opioid therapy and continue throughout treatment.\nNevertheless, laxatives are not routinely coprescribed with opioids. Even when concurrent laxatives are prescribed, approximately\nhalf the patients treated for OIC do not achieve the desired improvement. Moreover, laxatives do not target the underlying cause\nof OIC (opioid binding to the ??-receptors in the enteric system) and as such are not very effective at managing OIC.The failure of\nlifestyle modification and laxatives to treat adequately many cases of OIC led to the concurrent use of peripherally acting opioid\nantagonists (such as methylnaltrexone bromide and naloxone) to reduce the incidence of gastrointestinal adverse events without\ncompromising analgesia. Judicious use of the various options to manageOICshould allowmore patients to benefit fromopioid analgesia.\nTherefore, this paper reviews the causes, consequences, andmanagement of OIC to help clinicians optimise opioid analgesia.
Loading....