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Clinical overview and considerations for the management of opioid-induced constipation in patients with chronic noncancer pain

The Clinical Journal of Pain Jan 11, 2019

Viscusi ER - In view of the observed association of opioid analgesics with chronic adverse effects, such as opioid-induced constipation (OIC), available and emerging prescription medications for OIC in patients with chronic noncancer pain were described, including concerns and challenges associated with OIC management. Laxatives are frequently identified as insufficient to reduce OIC, as these do not affect the underlying disruption of gastrointestinal motility and water retention produced by opioid analgesics. For improving OIC in these patients, peripherally acting µ-opioid receptor antagonists (PAMORA; methylnaltrexone, naloxegol, naldemedine), and a chloride channel activator (lubiprostone) are identified as effective in phase 3 studies. These medications often induce gastrointestinal-related adverse events but do not usually necessitate discontinuation, especially with proper dose adjustment. Opioid withdrawal symptoms are generally rare. Health care providers are recommended to have information regarding this complication in patients receiving opioids. Further, they should monitor and address constipation-related symptoms to optimize pain management and improve patient quality of life.
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