Opioid-induced constipation in adult oncology patients
Keywords:
Constipation, opioids, intestinal elimination, pain, cancerAbstract
Opioids are gold-standard for the treatment of cancer pain, but some of its adverse effects may compromise its therapeutic potential, such as constipation. This change in elimination pattern is characterized by reduced bowel movements, increased effort in bowel movements, incomplete rectal evacuation sensation, or hard stool consistency. The prevention and treatment of constipation requires a rigorous assessment, mainly in patients at risk and a complete understanding of its aetiology. The assessment requires data collection patient’s clinical history, focusing on the level of physical activity, eating habits, chewing and swallowing ability, underlying medical problems and changes in bowel habits and stool characteristics. It also requires an accurate physical examination (oral cavity, abdominal region and anorectal).
In the presence of opioid-induced constipation, pharmacological measures (with laxative effect and /or inhibitors of intestinal opioid receptors, without loss of analgesic efficacy and opioid rotation) and non-pharmacological measures (food hygiene measures, bowel education and abdominal massage).
In this article we intend to make a theoretical framework of OIO and present prevention and control
measures aimed at improving the care provided by nurses and consequently a better quality of life for
those we care for.
Downloads
References
Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. (2012) Epidemiology of chronic pain: a population-based nationwide study on its prevalence, characteristics and associated disability in Portugal. The Journal Of Pain, vol 13, no 8, 773-783.
Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. (2013) A population-based study on chronic pain and the use of opioids in Portugal. PAIN®, vol 154, nº12, 2844–2852.
World Health Organization (1996). Cancer Pain Relief, 2nded. Geneva.
Holzer P. (2007). Treatment of opioid-induced gut dysfunction. Expert Opinion on Investigational Drugs, 16, 181–94.
Kalso E, Edwards JE, Moore RA, McQuay HJ. (2004). Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain, vol. 112, no. 3, 372–380.
Camilleri M, Drossman DA, Becker G, Webster LR, Davies AN, Mawe, GM. (2014). Emerging Treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation. Neurogastroenterol Motility, 26(10), 1386–1395.
Cimprich B. (1958). Symptom management: constipation. Cancer Nurs, vol.8, 39-43.
Simren, M., Palsson, O. S., & Whitehead, W. E. (2017). Update on Rome IV criteria for colorectal disorders: implications for clinical practice. Current Gastroenterology Reports, 19(4), 15. http://doi.org/10.1007/s11894-017-0554-0
Joseph V. Pergolizzi Jr. Md. (2015). Opioid-induced constipation: treating the patient holistically. Pain Medicine News. Disponível online em http://www.painmedicinenews.com/download/OIC_PMN0815_WM.pdf. Acedido em 5/03/2017.
Susan C. McMillan. (2004). Assessing and managing opiate-induced constipation in adults with cancer. Cancer Control, Vol. 11, nº 3, Supplement 1, 3-9.
Fallon M, O’Neill, B (1997). ABC of palliative care. Constipation and diarrhea. BMJ: British Medical Journal, 315(7118), 1293–1296.
Dueñas M, Mendonça L, Sampaio R, Gouvinhas C, Oliveira D, Castro-Lopes JM, Azevedo L.F. (2017). Reliability and validity of the Bowel Function Index for evaluating opioid-induced constipation: translation, cultural adaptation and validation of the Portuguese version (BFI-P). Current Medical Research And Opinion. Vol. 33, 3. Disponível em http://www.tandfonline.com/doi/full/10.1080/03007995.2016.1273204
Sykes, N. (1998). The treatment of morphine-induced constipation. European Journal of Palliative Care, 5(1), 12-5.
Bell T, Annunziata K, Leslie JB. (2009). Opioid-induced constipation negatively impacts pain management and health-related quality of life: findings from the National Health and Wellness Survey. Journal of Opioid Management, 5, 137-144.
Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, 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: 35-42.
Swegle JM, Logemann C. (2006). Management of common opioid-induced adverse effects. American Family Physician, Oct 15; 74(8):1347-54.
M. (2001). Incidence, prevalence, and management of opioid bowel dysfunction. The American Journal of Surgery, 182(5A Suppl):11S-18S.
Alame AM, Bahna H.(2012). Evaluation of constipation. Clinics in Colon and Rectal Surgery, 25(1):5-11.
Dorn S, Lembo A, Cremonini F (2014). Opioid-induced bowel dysfunction: epidemiology, pathophysiology, diagnosis, and initial therapeutic approach.The American Journal of Gastroenterology, 2(1), 31-37.
Turan N, Aşti TA. (2016) The effect of abdominal massage on constipation and quality of life. Gastroenterology Nursing, 39:48-59.
Lämås K, Lindholm L, Stenlund H, Engström B, Jacobsson C. (2009) Effects of abdominal massage in management of constipation - A randomized controlled trial. International Journal of Nursing Studies, 46:759-767.
Dhingra L, et al. (2013) A qualitative study to explore psychological distress and illness burden associated with opioid-induced constipation in cancer patients with advanced disease. Palliative Medicine, 27(5):447-456.
Hadley G, Derry S, Moore RA, Wiffen PJ. (2013) Transdermal fentanyl for cancer pain. Cochrane Database Systematic Review. Oct 5 (10):CD010270.
Davis MP (2012). Twelve reasons for considering buprenorphine as a frontline analgesic in the management of pain. The Journal Supportive Oncology, 10(6):209-219.
Merchant S, et al. (2013). Composite measure to assess efficacy/gastrointestinal tolerability of tapentadol ER versus Oxycodone CR for chronic pain: pooled analysis of randomized studies. Journal of Opioid Management, 9(1):51-61.
Goodheart C, Leavitt S. (2006). Managing opioid-induced constipation in ambulatory-care patients. Disponível em http://paincommunity.org/blog/wp-content/uploads/Managing_Opioid-Induced_Constipation.pdf
Leppert, W. (2012). The impact of opioid analgesics on the gastrointestinal tract function and the current management possibilities. Contemporary Oncology, 16(2), 125–131.
Larkin PJ, Sykes NP, Centeno C, et al (2008) The management of constipation in palliative care: clinical practice recommendations. Palliative Medicine, 22:796–807.
Mancini I, Bruera E. Constipation. In: Ripamonti C, Bruera E, editors. Gastrointestinal symptoms in advanced cancer patients. Oxford: Oxford University Press; 2004. pp. 193–206.
Zdanowicz MM (2016) Treatment of opioid-induced constipation: a therapeutic update. Journal of Advanced Practices in Nursing, 1:118. Vol 1, no 3.
Camilleri et al. Opioid-induced constipation: advances and clinical guidance. Therapeutic Advances in Chronic Disease, vol 7, no 2, 2016: pp 121–134.
Prichard, D., Norton C., Bharucha, A. Management of opioid-induced constipation. British Journal of Nursing, Vol 25, no 10, 2016; pp. 4-11
Thomas et al. Methylnaltrexone for opioid-induced constipation in advanced illness The New England Journal of Medicine; vol 358, no 22, 2008: pp 2332-43
Pergolizzi Jr.et al. Peripherally acting µ-opioid receptor antagonists as treatment options for constipation in noncancer pain patients on chronic opioid therapy - Patient Preference and Adherence 2017:11 107–119.
Van den Beuken-van Everdingen, Marieke H.J. et al. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. Journal of Pain and Symptom Management. 2016 Jun;51(6):1070-1090.e9.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2017 Daniela Dias, Juliana Santos, Carina Raposo, Luís Batalha, Ana Leonor Ribeiro, Ana Cristina Ferreira
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.