Opioid-Induced Constipation in Advanced Cancer Patients.

Nabil Almouaalamy

doi:10.7759/cureus.14386

Abstract

The present study discusses opioid-induced constipation (OIC) in advanced cancer patients, focusing on the OIC definition, pathophysiology, and treatment. OIC is any change from baseline defecation patterns and bowel habits that developed after starting opioid therapy. The condition is characterized by bowel frequency reduction, worsening or development of straining, a sensation of incomplete defecation, or distress associated with bowel habits. OIC is common in advanced cancer patients, with a prevalence of approximately 51%-87% in patients taking opioids for pain management. Patients are likely to experience severe distress, work productivity reduction, poor quality of life, and increased healthcare utilization. OIC has a complex pathophysiology that involves propulsive and peristalsis impairment, intestinal mucosal secretion inhibition, intestinal fluid absorption enhancement, and anal sphincters function impairment. The Rome III criteria are used to assess and diagnose clinical OIC and can also be diagnosed through the Patient Assessment of Constipation (PAC) measures, including the symptom survey (PAC-SYM) and quality of life survey (PAC-QOL). Non-pharmacological treatment of OIC involves lifestyle habits and dietary adjustments, although these interventions might be insufficient to manage the condition. Pharmacological treatments involve the use of traditional laxatives and newer agents like peripherally acting mu-opioid receptor agonists (PAMORAs), including naldemedine, naloxegol, and methylnaltrexone. More novel treatments for OIC that target the pathophysiology are still needed and should be studied carefully for safety and efficacy.

Highlights

BackgroundPain is a serious concern for people who are diagnosed with different forms of cancer
opioid-induced constipation (OIC) is any change from baseline defecation patterns and bowel habits that developed after starting opioid therapy
The American Society of Clinical Oncology recommends the use of opioids to manage pain in selected cancer patients who are unresponsive to conservative pain management approaches and continue to experience functional impairment or distress [2]

Summary

Introduction

Pain is a serious concern for people who are diagnosed with different forms of cancer. Cancer patients tend to discontinue or avoid opioid therapy because of OIC, which might cause them to sacrifice effective pain control to prevent constipation [3]. Any of these changes can be a symptom of OIC if they develop upon opioid therapy initiation. Even though Rome III criteria have been created for functional constipation, they offer a standardized OIC definition This assessment standard comprises straining at defecation, hard stools, anorectal obstruction or a feeling of incomplete defecation, reliance on manual aids to facilitate stools passage, and passing under three stools a week [11].

Loose stools are rarely present without the use of laxatives

Total score

Conclusions

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Disclosures