title: Opioid-induced constipation in chronic noncancer pain.
abstract: OBJECTIVE
  Opioid-based management of noncancer pain has become much more prevalent over the last 2 decades and is responsible for a wide range of side-effects, particularly affecting the intestinal tract causing opioid-induced constipation (OIC). This review will consider results of recent clinical trials that have provided evidence of new pharmacological management options for the treatment of OIC.
  
  
  RESULTS
  Supportive use of conventional agents, such as stool softeners, osmotic laxatives, and stimulating laxatives in OIC has limited efficacy. The peripheral μ-opioid receptor antagonist (PAMORA) methylnaltrexone (MNTX) was first FDA approved for OIC in patients with advanced illness and later also for OIC in noncancer pain patients; clinical trial results indicated MNTX did not reverse opioid analgesia and did not trigger central opioid withdrawal. Another PAMORA, the orally available naloxegol, has also gained recent FDA approval for the treatment of OIC in adults with chronic, noncancer pain. Lubiprostone, a bicyclical fatty acid acting via activation of intestinal chloride channel-2 (ClC-2), was also approved for OIC treatment in patients with noncancer pain.
  
  
  CONCLUSIONS
  PAMORA MNTX and naloxegol and the intestinal chloride channel-2 (ClC-2) activator lubiprostone represent additional possible therapeutic options for the management of OIC in patients with chronic noncancer pain.
authors.affiliation: Section of Gastroenterology, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: H Christian
authors.initials: HC
authors.lastname: Weber
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D065101:Chloride Channel Agonists / Q000494:pharmacology*; D059350:Chronic Pain / Q000188:drug therapy*; D003248:Constipation / Q000139:chemically induced* / Q000188:drug therapy*; D006801:Humans; D000068238:Lubiprostone / Q000494:pharmacology*; D009019:Morphinans / Q000494:pharmacology*; D009271:Naltrexone / Q000031:analogs & derivatives* / Q000494:pharmacology; D009292:Narcotic Antagonists / Q000494:pharmacology*; D011092:Polyethylene Glycols / Q000494:pharmacology*; D000644:Quaternary Ammonium Compounds / Q000494:pharmacology; D017450:Receptors, Opioid, mu / Q000037:antagonists & inhibitors*
chemical_list: D000701:Analgesics, Opioid; D065101:Chloride Channel Agonists; D009019:Morphinans; D009292:Narcotic Antagonists; D000644:Quaternary Ammonium Compounds; D017450:Receptors, Opioid, mu; C032257:methylnaltrexone; D011092:Polyethylene Glycols; C000589308:naloxegol; D009271:Naltrexone; D000068238:Lubiprostone