Abstract
Constipation, one of the adverse effects of opioid therapy with a major impact on quality of life, is still an unmet need for cancer patients, particularly those with an advanced and progressive disease, and for non-cancer patients chronically treated with opioids. The awareness of this condition is poor among healthcare providers, despite the recent publication of guidelines and consensus conferences. An early multidisciplinary approach of opioid-induced bowel dysfunction (OIBD), based on available therapies of proven effectiveness, could support clinicians in managing this condition, thus increasing patients’ adherence to pain therapy. Several Italian experts involved in the management of patients suffering from pain (anaesthesia pain therapy, oncology, haematology, palliative care, gastroenterology) joined in a Board in order to draw up an expert opinion on OIBD. The most frequent and still unsolved issues in this field were examined, including a more comprehensive definition of OIBD, the benefits of early intervention to prevent its occurrence and the most appropriate use of peripherally acting mu-opioid receptor antagonists (PAMORAs). The use of the recently introduced PAMORA naloxegol was analysed, in light of the current literature. The Board proposed a solution for each open issue in the form of recommendations, integrated with the contribution of representatives from different disciplines and often accompanied by procedural algorithms immediately usable and applicable in daily clinical practice. Safety and quality of life of the patient suffering from pain and from the adverse effects of pain therapies have been the mainstays of this expert opinion, in cooperation with general practitioners and caregivers.
Highlights
The optimal management of opioid therapy–induced adverse effects is still an unmet need
The pivotal trials of naloxegol showed that the response rate achieved with naloxegol 25 mg was 14–15% higher compared to placebo, whereas in the subpopulation with inadequate laxative response (LIR), the response rate difference between naloxegol 25 mg and placebo exceeded 20% and the number of patients to be treated due to non-response was halved [16, 29]
The treatment of opioid-induced bowel dysfunction (OIBD) should be managed by a multidisciplinary team, and it is advisable to involve general practitioners, because patients on opioid therapy very often receive both hospital and home care
Summary
The optimal management of opioid therapy–induced adverse effects is still an unmet need. Administering the drug every 2 days if abdominal pain occurs is not advisable; the only possible solution is a dose reduction or discontinuation of therapy [35] and to consider the impact of such events on patients’ quality of life in comparison to the constipation they were experiencing before starting naloxegol. Another frequent event to be monitored is the patient’s selfinterruption of medication once evacuation has occurred. – in case of a switch from oxycodone plus naloxone to only oxycodone, naloxegol should be associated if OIBD occurs
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