title: Constipation in Elderly Patients with Noncancer Pain: Focus on Opioid-Induced Constipation.
abstract: Constipation is a common and often debilitating condition in the elderly, which may be caused by underlying disease conditions, structural abnormalities in the bowel, and a variety of medications such as anticholinergics, antidepressants, and opiates. In this review, we focus on opioid-induced constipation (OIC), which is often underrecognized and undertreated in the elderly. When opioid therapy is initiated, healthcare providers are encouraged to evaluate risk factors for the development of constipation as part of a thorough patient history. To this end, the patient assessment should include the use of validated instruments, such as the Bristol Stool Scale and Bowel Function Index, to confirm the diagnosis and provide a basis for evaluating treatment outcomes. Healthcare providers should use a stepwise approach to the treatment of OIC in the elderly. Conventional laxatives are a first-line option and considered well tolerated with short-term use as needed; however, evidence is lacking to support their effectiveness in OIC. Moreover, because of the risk of adverse events and other considerations, such as chewing difficulties and swallowing disorders, conventional oral laxatives may be inappropriate for the treatment of OIC in the elderly. Thus, the availability of new pharmacologic agents such as the peripherally acting µ-opioid receptor antagonists methylnaltrexone and naloxegol, which target the underlying causes of OIC, and the secretagogue lubiprostone may provide more effective treatment options for elderly patients with OIC.
authors.affiliation: Division of Gastroenterology and Hepatology, Rutgers, Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB Room 478C, New Brunswick, NJ, 08901, USA. sita.chokhavatia@rutgers.edu.|Internal Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA. sita.chokhavatia@rutgers.edu.
authors.forename: Sita
authors.initials: S
authors.lastname: Chokhavatia
authors.affiliation: Division of Gastroenterology and Hepatology, Rutgers, Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB Room 478C, New Brunswick, NJ, 08901, USA.|Internal Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: John
authors.affiliation: Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.|Internal Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
authors.forename: Mary Barna
authors.initials: MB
authors.lastname: Bridgeman
authors.affiliation: Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.|Critical Care, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
authors.forename: Deepali
authors.initials: D
authors.lastname: Dixit
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003248:Constipation / Q000139:chemically induced* / Q000188:drug therapy; D006282:Health Personnel; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage / Q000627:therapeutic use; D009271:Naltrexone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D000644:Quaternary Ammonium Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D017450:Receptors, Opioid, mu / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D054368:Laxatives; D009292:Narcotic Antagonists; D000644:Quaternary Ammonium Compounds; D017450:Receptors, Opioid, mu; C032257:methylnaltrexone; D009271:Naltrexone