Opioid-induced constipation in chronic pain: Experience with 180 patients

Abstract

Background: Opioid-induced constipation (OIC) is a common adverse effect of opioid analgesic therapy that significantly affects the patient's quality of life and may lead to poor adherence and treatment failure. Tapentadol, oxycodone/naloxone, and some transcutaneous opioids were associated with less frequent OIC than morphine or oxycodone in controlled clinical trials. However, few studies compare these newer opioids with each other in terms of OIC.Methods and patients: We performed a cross-sectional observational study that evaluated the degree of OIC and risk factors in patients receiving long-term treatment (1 year) at a tertiary care pain unit with tapentadol, oxycodone/naloxone, hydromorphone, fentanyl, or buprenorphine. The degree of constipation was evaluated using the Bowel Function Index (BFI).Results: Out of 180 enrolled patients (median age: 61.5 years, 66.7 percent women, mean treatment duration: 3 years), 57.2 percent suffered from nociceptive pain, 33.9 percent from mixed pain, and 8.9 percent from neuropathic pain. The most commonly prescribed opioids were oxycodone/naloxone (44.4 percent) and tapentadol (37.8 percent). At the time of the study, 73.9 percent of patients had constipation (BFI 29), and 21.7 percent had severe constipation (BFI 69). In a multiple linear regression analysis, previous constipation, morphine equivalent dose, treatment with fentanyl and interaction between morphine equivalent dose and hydromorphone were associated with more severe constipation. Conclusions: Most patients receiving long-term treatment with opioids present symptoms of constipation. The bowel function profile was more favorable for tapentadol and oxycodone, with no differences between them, even though morphine equivalent doses were on average higher in the tapentadol group.

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

“…In a 2017 Chinese systematic review and meta-analysis of RCTs (overall 3217 patients with chronic pain), Huang et al [ 136 ] discovered that treatment with a fixed-ratio combination of prolonged-release oxycodone/naloxone reduces the incidence of opioid-induced constipation and provides clinically significant intermediate-term bowel function improvement while maintaining pain relief. According to a 2019 Spanish study by Velázquez Rivera et al [ 137 ], tapentadol and oxycodone had better bowel function profiles with no differences in a cross-sectional observational study of 180 Spanish patients with opioid-induced constipation during long-term treatment.…”

The Safety of Drug Treatment in Patients with Neuropathic Pain: Data from Ambulatory Care in a Real-Life Setting

“…ADRs represent a serious problem during the treatment of patients with pain (i.e., anticholinergic effects for tricyclic antidepressants [8], abuse and misuse of gabapentinoids in patients using opioids [9], and constipation during opioid treatment [10].…”