Opioid-induced bowel dysfunction: a literature review
DOI:
https://doi.org/10.12775/JEHS.2023.22.01.012Keywords
opioid-induced bowel dysfunction, OIBD, opioid-induced constipation, OIC, opioids, adverse effects, gastrointestinal motility, laxatives, PAMORAs, peripherally acting mu-opioid receptor antagonistsAbstract
Opioid therapy plays a crucial role in the management of acute and chronic pain, with opioids being widely prescribed worldwide. However, alongside the analgesic benefits, the use of opioids is associated with a range of adverse effects, including opioid-induced bowel dysfunction. Opioid-induced bowel dysfunction refers to a constellation of gastrointestinal symptoms caused by the effects of opioids on the gastrointestinal tract. These symptoms primarily manifest as constipation, but can also include abdominal pain, bloating, nausea, and vomiting. Opioid-induced bowel dysfunction poses a significant clinical challenge, as it can severely affect patients' quality of life. Non-pharmacological approaches alone are rarely sufficient to counteract the adverse effects of opioid therapy. The primary pharmacological agents used in opioid-induced bowel dysfunction management are laxatives, which should be chosen according to individual patient needs. Patients with poorly controlled symptoms can benefit from new pharmacological approaches, particularly peripheral mu-opioid receptor antagonists. By better understanding the underlying mechanisms, clinical manifestations, diagnostic criteria, and management strategies, healthcare professionals can optimize patient care, minimize complications, and improve patients' overall well-being.
References
Busch-Dienstfertig, M., & Stein, C. (2010). Opioid receptors and opioid peptide-producing leukocytes in inflammatory pain–basic and therapeutic aspects. Brain, behavior, and immunity, 24(5), 683-694.
https://doi.org/10.1016/j.bbi.2009.10.013
Bell, T., Milanova, T., Grove, G., Williamson, R., & Bolge, S. (2006). 663 PREVALENCE, SEVERITY AND IMPACT OF OPIOID‐INDUCED GI SIDE EFFECTS IN THE EU: RESULTS OF A PATIENT SURVEY. European Journal of Pain, 10(S1), S173b-S173.
https://doi.org/10.1016/S1090-3801(06)60666-6
Stein C, Schafer M and Machelska H. Attacking pain at its source: new perspectives on opioids. Nat Med 2003; 9(8): 1003–1008.
James, A., & Williams, J. (2020). Basic opioid pharmacology—an update. British journal of pain, 14(2), 115-121.
https://doi.org/10.1177/2049463720911986
Panchal, S. J., Müller‐Schwefe, P. J. I. W., & Wurzelmann, J. I. (2007). Opioid‐induced bowel dysfunction: prevalence, pathophysiology and burden. International journal of clinical practice, 61(7), 1181-1187.
https://doi.org/10.1111/j.1742-1241.2007.01415.x
Sarna, S. K., & Otterson, M. F. (1990). Small intestinal amyogenesia and dysmyogenesia induced by morphine and loperamide. American Journal of Physiology-Gastrointestinal and Liver Physiology, 258(2), G282-G289.
https://doi.org/10.1152/ajpgi.1990.258.2.G282
Wood, J. D., & Galligan, J. (2004). Function of opioids in the enteric nervous system. Neurogastroenterology & Motility, 16, 17-28.
https://doi.org/10.1111/j.1743-3150.2004.00554.x
Thomas, J. (2008). Opioid-induced bowel dysfunction. Journal of pain and symptom management, 35(1), 103-113.
https://doi.org/10.1016/j.jpainsymman.2007.01.017
Kraichely, R. E., Arora, A. S., & Murray, J. A. (2010). Opiate‐induced oesophageal dysmotility. Alimentary pharmacology & therapeutics, 31(5), 601-606.
https://doi.org/10.1111/j.1365-2036.2009.04212.x
Tuteja, A. K., Biskupiak, J., Stoddard, G. J., & Lipman, A. G. (2010). Opioid‐induced bowel disorders and narcotic bowel syndrome in patients with chronic non‐cancer pain. Neurogastroenterology & Motility, 22(4), 424-e96.
https://doi.org/10.1111/j.1365-2982.2009.01458.x
Bell, T. J., Panchal, S. J., Miaskowski, C., Bolge, S. C., Milanova, T., & Williamson, R. (2009). The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain medicine, 10(1), 35-42.
https://doi.org/10.1111/j.1526-4637.2008.00495.x
Norton, C. (2006). Constipation in older patients: effects on quality of life. British Journal of Nursing, 15(4), 188-192.
https://doi.org/10.12968/bjon.2006.15.4.20542
Locke III, G. R., Zinsmeister, A. R., Schleck, C. D., & Talley, N. J. (2009). Opioid bowel dysfunction and narcotic bowel syndrome: a population-based study. The American journal of gastroenterology, 104(5), 1199.
https://doi.org/10.1038%2Fajg.2009.71
Azizi, Z., Anbardan, S. J., & Daryani, N. E. (2014). A review of the clinical manifestations, pathophysiology and management of opioid bowel dysfunction and narcotic bowel syndrome. Middle East Journal of Digestive Diseases, 6(1), 5.
Mehendale, S. R., & Yuan, C. S. (2006). Opioid-induced gastrointestinal dysfunction. Digestive diseases, 24(1-2), 105-112.
https://doi.org/10.1159/000090314
Klepstad, P., Borchgrevink, P. C., & Kaasa, S. (2000). Effects on cancer patients' health-related quality of life after the start of morphine therapy. Journal of pain and Symptom Management, 20(1), 19-26.
https://doi.org/10.1016/S0885-3924(00)00167-6
Ducrotté, P., & Caussé, C. (2012). The Bowel Function Index: a new validated scale for assessing opioid-induced constipation. Current medical research and opinion, 28(3), 457-466.
https://doi.org/10.1185/03007995.2012.657301
Argoff, C. E., Brennan, M. J., Camilleri, M., Davies, A., Fudin, J., Galluzzi, K. E., ... & Webster, L. R. (2015). Consensus recommendations on initiating prescription therapies for opioid-induced constipation. Pain Medicine, 16(12), 2324-2337.
https://doi.org/10.1111/pme.12937
Long, M. D., Barnes, E. L., Herfarth, H. H., & Drossman, D. A. (2012). Narcotic use for inflammatory bowel disease and risk factors during hospitalization. Inflammatory bowel diseases, 18(5), 869-876.
https://doi.org/10.1002/ibd.21806
Dinning, P. G., Smith, T. K., & Scott, S. M. (2009). Pathophysiology of colonic causes of chronic constipation. Neurogastroenterology & Motility, 21, 20-30.
https://doi.org/10.1111/j.1365-2982.2009.01401.x
Thorpe, D. M. (2001). Management of opioid-induced constipation. Current pain and headache reports, 5, 237-240.
https://doi.org/10.1007/s11916-001-0037-7
Pappagallo, M. (2001). Incidence, prevalence, and management of opioid bowel dysfunction. The American journal of surgery, 182(5), S11-S18.
https://doi.org/10.1016/S0002-9610(01)00782-6
Larkin, P. J., Cherny, N. I., La Carpia, D., Guglielmo, M., Ostgathe, C., Scotté, F., & Ripamonti, C. I. (2018). Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines. Annals of oncology, 29, iv111-iv125.
https://doi.org/10.1093/annonc/mdy148
Herndon, C. M., Jackson, K. C., & Hallin, P. A. (2002). Management of opioid‐induced gastrointestinal effects in patients receiving palliative care. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 22(2), 240-250.
https://doi.org/10.1592/phco.22.3.240.33552
Candy, B., Jones, L., Vickerstaff, V., Larkin, P. J., & Stone, P. (2022). Mu‐opioid antagonists for opioid‐induced bowel dysfunction in people with cancer and people receiving palliative care. Cochrane Database of Systematic Reviews, (9).
https://doi.org/10.1002/14651858.CD006332.pub4
Katakami, N., Harada, T., Murata, T., Shinozaki, K., Tsutsumi, M., Yokota, T., ... & Boku, N. (2017). Randomized phase III and extension studies of naldemedine in patients with opioid-induced constipation and cancer. Journal of Clinical Oncology, 35(34), 3859-3866.
https://doi.org/10.1200/JCO.2017.73.0853
Chey, W. D., Webster, L., Sostek, M., Lappalainen, J., Barker, P. N., & Tack, J. (2014). Naloxegol for opioid-induced constipation in patients with noncancer pain. New England Journal of Medicine, 370(25), 2387-2396.
https://doi.org/10.1056/NEJMoa1310246
Coluzzi, F., Scerpa, M. S., & Pergolizzi, J. (2020). Naldemedine: a new option for OIBD. Journal of Pain Research, 1209-1222.
https://doi.org/10.2147/JPR.S243435
Bull, J., Wellman, C. V., Israel, R. J., Barrett, A. C., Paterson, C., & Forbes, W. P. (2015). Fixed-dose subcutaneous methylnaltrexone in patients with advanced illness and opioid-induced constipation: results of a randomized, placebo-controlled study and open-label extension. Journal of palliative medicine, 18(7), 593-600.
https://doi.org/10.1089/jpm.2014.0362
Mori, M., Ji, Y., Kumar, S., Ashikaga, T., & Ades, S. (2017). Phase II trial of subcutaneous methylnaltrexone in the treatment of severe opioid-induced constipation (OIC) in cancer patients: an exploratory study. International journal of clinical oncology, 22, 397-404.
https://doi.org/10.1007/s10147-016-1041-6
Sridharan, K., & Sivaramakrishnan, G. (2018). Drugs for treating opioid-induced constipation: a mixed treatment comparison network meta-analysis of randomized controlled clinical trials. Journal of pain and symptom management, 55(2), 468-479.
https://doi.org/10.1016/j.jpainsymman.2017.08.022
Lazzari, M., Greco, M. T., Marcassa, C., Finocchi, S., Caldarulo, C., & Corli, O. (2015). Efficacy and tolerability of oral oxycodone and oxycodone/naloxone combination in opioid-naive cancer patients: a propensity analysis. Drug design, development and therapy, 9, 5863.
https://doi.org/10.2147%2FDDDT.S92998
Morlion, B. J., Mueller‐Lissner, S. A., Vellucci, R., Leppert, W., Coffin, B. C., Dickerson, S. L., & O'Brien, T. (2018). Oral prolonged‐release oxycodone/naloxone for managing pain and opioid‐induced constipation: a review of the evidence. Pain Practice, 18(5), 647-665.
https://doi.org/10.1111/papr.12646
Amato, F., Ceniti, S., Mameli, S., Pisanu, G. M., Vellucci, R., Palmieri, V., ... & Marcassa, C. (2017). High dosage of a fixed combination oxycodone/naloxone prolonged release: efficacy and tolerability in patients with chronic cancer pain. Supportive Care in Cancer, 25, 3051-3058.
https://doi.org/10.1007/s00520-017-3709-5
Leppert, W., Zajaczkowska, R., & Wordliczek, J. (2019). The role of oxycodone/naloxone in the management of patients with pain and opioid-induced constipation. Expert Opinion on Pharmacotherapy, 20(5), 511-522.
https://doi.org/10.1080/14656566.2018.1561863
Rossi, M., Casale, G., Badiali, D., Aielli, F., Aloe Spiriti, M. A., Arcioni, R., ... & Marchetti, P. (2019). Opioid-induced bowel dysfunction: suggestions from a multidisciplinary expert Board. Supportive Care in Cancer, 27, 4083-4090.
https://doi.org/10.1007/s00520-019-04688-2
Bomhof-Roordink, H., Gärtner, F. R., Stiggelbout, A. M., & Pieterse, A. H. (2019). Key components of shared decision making models: a systematic review. BMJ open, 9(12), e031763.
https://doi.org/10.1136/bmjopen-2019-031763
Hughes, T. M., Merath, K., Chen, Q., Sun, S., Palmer, E., Idrees, J. J., ... & Pawlik, T. M. (2018). Association of shared decision-making on patient-reported health outcomes and healthcare utilization. The American Journal of Surgery, 216(1), 7-12.
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