How to Manage Opioid-Related Constipation in Individuals With Chronic Nonmalignant Pain Syndromes

Incidence, pathophysiology, and implications of opioid‐induced constipation and suggestions for patient‐provider interactions

“…Thus, opioid-related constipation may develop directly as result of new exposure to opioids, for which the term OIC would be appropriate, or due to worsening of baseline constipation symptoms, more accurately termed opioid exacerbated constipation (OEC). 23 From a clinical perspective, these nuances are important to appreciate, as more than 15% of the population suffers from occasional or chronic constipation unrelated to the use of opioids and treatment protocols can differ for OIC and OEC, considering the multifactorial pathogenesis of OEC. To that end, a simple diagnostic algorithm for differentiating OIC and OEC has been proposed.…”

“… 22 The strength of both definitions described above is their inherent recognition that patients can experience signs and symptoms of constipation prior to the onset of opioid therapy, and that the addition of opioids can exacerbate an already extant disorder. Thus, opioid‐related constipation may develop directly as result of new exposure to opioids, for which the term OIC would be appropriate, or due to worsening of baseline constipation symptoms, more accurately termed opioid exacerbated constipation (OEC) 23 . From a clinical perspective, these nuances are important to appreciate, as more than 15% of the population suffers from occasional or chronic constipation unrelated to the use of opioids and treatment protocols can differ for OIC and OEC, considering the multifactorial pathogenesis of OEC.…”

“…From a clinical perspective, these nuances are important to appreciate, as more than 15% of the population suffers from occasional or chronic constipation unrelated to the use of opioids and treatment protocols can differ for OIC and OEC, considering the multifactorial pathogenesis of OEC. To that end, a simple diagnostic algorithm for differentiating OIC and OEC has been proposed 23 …”

Reflections on Our Editorship of The American Journal of Gastroenterology

“…Opioid use is pervasive across all medical specialties; digestive diseases are not immune to this trend. The Journal featured many insightful studies casting light on the problem of opioid overuse and related consequences among patients with GI and liver diseases (36)(37)(38)(39)(40). We hope in years to come that researchers continue to identify ways to minimize opioid use among our patients while also maintaining compassion and understanding that some people do need these medications; this is a delicate conversation that must continue in the pages of AJG.…”