Opioid-induced bowel dysfunction (OIBD) is an increasing problem due to the common use of opioids for chronic pain worldwide. It manifests with different symptoms, such as dry mouth, gastro-oesophageal reflux, vomiting, bloating, abdominal pain, anorexia, hard stools, constipation and incomplete evacuation. Opioid-induced constipation (OIC) is one of its many symptoms and probably the most prevalent.
There are no available tools to assess OIBD, but many rating scales have been developed to assess constipation, and a few specifically address OIC. A clinical treatment strategy for OIBD/OIC was proposed and presented in a flowchart. First-line treatment of OIC is conventional laxatives, lifestyle changes, tapering the opioid dosage and alternative analgesics. While opioid rotation may also improve symptoms, these remain unalleviated in a substantial proportion of patients. Should conventional treatment fail, mechanism-based treatment with opioid antagonists should be considered, and they show advantages over laxatives. It should not be overlooked that many reasons for constipation other than OIBD exist, which should be taken into consideration in the individual patient.
Considering methylnaltrexone?
There are publications with expriences of using it. (linked one from NEJM)
Regards,
Karlo
http://www.nejm.org/doi/full/10.1056/nejmoa0707377#t=article
Hello,
Do you use opioids to treat acute or chronic pain?
In my opinion, its not the same at all if you need opioids for short term analgesia and every strategy discribed above is nice.
If you want to treat chronic pain, I would say that you have to find non-pharmacological strategies to treat the patient's pain. It's the better prevention.
Have a nice day, Phil.
Thank you very much Philippe for your answer. The idea is to prevent OIBD in patients taking opioids for chronic cancer and specially non-cancer pain due to its high and still growing worldwide prevalence.
I agree, it's a great problem for all these patients.
In our pain center we only treat non cancer pain and I use opioids as litlle as possible due to OIBD and others problems.
I mix Trans Electrical Nerve Stimulation (TENS), ketamine, physiotherapy, acupuncture, psychotherapy, hypnosis, patient education, topics (lidocaïne, capsaïcine), transcranial stimulation (rTMS), physical activity and medications with good results.
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