Opioid-Induced Constipation in Oncological Patients: New Strategies of Management

Mesı́a, Ricard; Echaburu, Juan Antonio Virizuela; Gómez, J Jiménez; Saurí, Tamara; Serrano, Gloria; Pujol, E.

doi:10.1007/s11864-019-0686-6

Cited by 31 publications

(36 citation statements)

References 62 publications

(55 reference statements)

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“…Constipation is often underestimated by the doctor and the patient [16,17], and therefore requires careful evaluation of both the objective and subjective symptoms. Opioids can induce OIC or exacerbate a pre-existing functional constipation and this should motivate the choice of the specific therapeutic line [18]. Laxative therapy is the first-line in OIC treatment [19,20], and its application is recommended from the beginning of opioid therapy (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Can Naloxegol Therapy Improve Quality of Life in Patients with Advanced Cancer?

Ostan

Gambino

Malavasi

et al. 2021

Cancers

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This observational study aims to evaluate the efficacy of naloxegol therapy in resolving opioid-induced constipation (OIC) and in improving the quality of life in a home palliative care cancer setting. Advanced cancer patients with OIC (Rome IV criteria) not relieved by laxatives started a naloxegol therapy 25 mg/day for 4 weeks. Quality of life was evaluated by Patient Assessment of Constipation Quality-of-Life (PAC-QoL) at day 0 and day 28; background pain by Numerical Rating Scale, number of weekly spontaneous bowel movements and Bowel Function Index (BFI) were evaluated at day 0 and every week. Seventy-eight patients who completed the 4-week study improved all four PAC-QoL dimensions (physical and psychological discomfort, worries/concerns and satisfaction level). Weekly spontaneous bowel movements increased and BFI improved. Background pain reduced after seven days and remained lower during the following weeks. Seventy-two patients dropped out the study before day 28 with a reduced survival compared to patients completing the study. Even in these patients, an improvement of bowel function was observed after two weeks. Naloxegol was effective in improving the quality of life, resolving OIC and reducing overall pain in patients with advanced cancer.

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Section: Introductionmentioning

confidence: 99%

Can Naloxegol Therapy Improve Quality of Life in Patients with Advanced Cancer?

Ostan

Gambino

Malavasi

et al. 2021

Cancers

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“…The aim of increased fibre intake is to accelerate colonic transit by stimulating gut motility, since undigested fibre increases faecal volume and causes colonic distension. However, by inhibiting intestinal motility, opioids may cause an excess of fibre in the colon; this can lead to fermentation, with bloating and flatulence, and increase the risk of faecalomas [ 123 ]. The recommendation to increase dietary fibre intake in patients with OIC is justified if fibre intake is normally inadequate and if colonic transit remains normal with or without using laxatives [ 41 , 124 ].…”

Section: Treatmentmentioning

confidence: 99%

Management of Opioid-Induced Constipation and Bowel Dysfunction: Expert Opinion of an Italian Multidisciplinary Panel

et al. 2021

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The prescribing and use of opioid analgesics is increasing in Italy owing to a profusion in the number and types of opioid analgesic products available, and the increasing prevalence of conditions associated with severe pain, the latter being related to population aging. Herein we provide the expert opinion of an Italian multidisciplinary panel on the management of opioid-induced constipation (OIC) and bowel dysfunction. OIC and opioid-induced bowel dysfunction are well-recognised unwanted effects of treatment with opioid analgesics that can profoundly affect quality of life. OIC can be due to additional factors such as reduced mobility, a low-fibre diet, comorbidities, and

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“…4 Among all the signs and symptoms of OIBD, opioid-induced constipation (OIC) is the most common, affecting up to 60% of patients with chronic non-cancer pain (CNCP) 5 and over 80% of patients suffering from cancer pain. 6 OIC is also one of the most common symptoms associated with opioid maintenance treatment, where high doses of buprenorphine and methadone are used as substitution treatment. 7 According to the Rome IV criteria for colorectal disorders, OIC has been classified among the "functional bowel disorders", based on the frequent symptomatic overlap and shared underlying mechanisms.…”

Section: Opioid-induced Bowel Dysfunction (Oibd)mentioning

confidence: 99%

<p>Naldemedine: A New Option for OIBD</p>

Coluzzi¹,

Scerpa²,

Pergolizzi³

2020

JPR

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Opioid-induced bowel dysfunction (OIBD) is a common complication in longterm opioid users and abusers. It is a burdensome condition, which significantly limits quality of life and is associated with increasing health costs. OIBD affects up to 60% of patients with chronic non-cancer pain and over 80% of patients suffering from cancer pain and is one of the conditions of the most common symptoms associated with opioid maintenance. Given the continued use of opioids for chronic pain management in appropriate patients, OIBD is likely to persist in clinical practice in the coming years. We will herein review its underlying pathophysiological mechanisms and the available treatments. In the last years, pharmaceutical research has focused on the opportunity of targeting peripheral muopioid receptors without affecting their analgesic activity in the central nervous system, and several peripherally acting mu-opioid receptors antagonists (PAMORAs) drugs have been approved. We will mainly focus on naldemedine, discussing its pharmacological properties, its clinical efficacy and side effects. Head-to-head comparisons between naldemedine and the other PAMORAs are not available yet, but some considerations will be discussed based on the pharmacological and clinical data. As a whole, the available data suggest that naldemedine is a valid treatment option for OIBD, as it is a well-tolerated drug that alleviates constipation without affecting analgesia or causing symptoms of opioid withdrawal.

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Opioid-Induced Constipation in Oncological Patients: New Strategies of Management

Cited by 31 publications

References 62 publications

Can Naloxegol Therapy Improve Quality of Life in Patients with Advanced Cancer?

Can Naloxegol Therapy Improve Quality of Life in Patients with Advanced Cancer?

Management of Opioid-Induced Constipation and Bowel Dysfunction: Expert Opinion of an Italian Multidisciplinary Panel

<p>Naldemedine: A New Option for OIBD</p>

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