title: Improving the recognition and diagnosis of opioid-induced constipation in clinical practice.
abstract: Opioid-induced constipation is a common side effect of opioid therapy that has been under-recognized and undertreated. With the continued increase in opioid use in the United States, along with the growth of the elderly population, more patients will develop OIC, and family physicians will encounter more patients with OIC. OIC negatively affects patient QOL, daily activity, work productivity, and psychological well-being. If not treated effectively, OIC may result in patients attempting to balance their pain relief against their constipation, by self-adjusting their opioid dose. OIC results from opioid actions at enteric opioid receptors. Although commonly prescribed for OIC, laxatives do not target the pathophysiologic mechanism of OIC and have limited efficacy. Specific, effective treatments for OIC, consisting of a subcutaneously administered PAMORA, an oral PAMORA, and an oral chloride channel activator, have been developed and have received US Food and Drug Administration approval. After recognizing the signs and symptoms of OIC to facilitate diagnosis, family physicians can initiate effective treatments in appropriate patients.
authors.affiliation: Vice Chair, Associate Professor, Drexel University College of Medicine, Division of Pain Medicine & Regional Anesthesiology, Department of Anesthesiology & Perioperative Medicine, Philadelphia, PA, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D065101:Chloride Channel Agonists / Q000627:therapeutic use; D003248:Constipation / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D007279:Injections, Subcutaneous; D000068238:Lubiprostone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D059408:Pain Management / Q000009:adverse effects* / Q000379:methods; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011788:Quality of Life; D017450:Receptors, Opioid, mu / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D065101:Chloride Channel Agonists; D009292:Narcotic Antagonists; D017450:Receptors, Opioid, mu; D000068238:Lubiprostone