Management of constipation in palliative care patients.
OBJECTIVE
Constipation is a common symptom in palliative care patients that can generate considerable suffering due to both unpleasant physical symptoms and psychological preoccupations that may arise. There is uncertainty about the choice from varying recommendations for management of constipation and a varying clinical practice in palliative care settings. The purpose of the review is to evaluate the current recommendations of therapy guidelines and to determine the effectiveness of laxative administration for the management of constipation in palliative care patients.


RESULTS
Recent findings in the literature include an updated version of the Rome criteria and related information on the functional gastrointestinal disorders, as well as information on opioid antagonists. Knowledge of the role of definitions, causes of constipation and the pathophysiology of opioid-induced constipation must be given a high priority in the treatment of patients receiving opioids. Diagnosis and therapy of constipation, therefore, should relate to findings in clinical investigation.


CONCLUSIONS
The treatment of constipation in palliative care is based on inadequate experimental evidence, such that there are insufficient randomized controlled trial data. Recommendations for laxative use can be related to efficacy. Particularly in patients with advanced-stage tumor disease this must be undertaken with careful consideration of their physical activity and dietary needs.
Clemens
Katri Elina
KE
Department of Science and Research, Center for Palliative Medicine, University of Bonn, Bonn, Germany. katri-elina.clemens@malteser.de
Klaschik
Eberhard
E
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D003248:Constipation / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000379:methods
D000701:Analgesics, Opioid; D054368:Laxatives