Laxatives Do Not Improve Symptoms of Opioid-Induced Constipation: Results of a Patient Survey.
BACKGROUND
Laxatives are commonly used to treat opioid-induced constipation, the commonest and most bothersome complication of opioids. However, laxatives have a nonspecific action and do not target underlying mechanisms of opioid-induced constipation; their use is associated with abdominal symptoms that negatively impact quality of life.


OBJECTIVE
To assess the effects of laxatives in patients taking opioids for chronic pain.


METHODS
One hundred ninety-eight UK patients who had taken opioid analgesics for at least one month completed a cross-sectional online or telephone survey. Questions addressed their pain condition, medication, and laxative use (including efficacy and side effects). The survey also assessed bowel function using the Bowel Function Index.


RESULTS
Since starting their current opioid, 134 of 184 patients (73%) had used laxatives at some point and 122 (91%) of these were currently taking them. The most common laxatives were osmotics and stimulants. Laxative side effects were reported in 75%, most commonly gas, bloating/fullness, and a sudden urge to defecate. Side effects were more common in patients less than 40 years of age. Approximately half of patients said laxatives interfered with work and social activities, and one-fifth needed an overnight hospital stay because of their pain condition and/or constipation. Laxatives did not improve the symptoms of constipation, as assessed by the Bowel Function Index. Constipation was not related to opioid strength, dose of opioid, or number of laxatives taken.


CONCLUSIONS
Use of laxatives to treat opioid-induced constipation is often ineffective and associated with side effects. Instead of relieving the burden of opioid-induced constipation, laxative use is associated with a negative impact.
Department of Gastroenterology, University College Hospital, London, UK.
Anton
A
Emmanuel
Chronic Pain Policy Coalition (CPPC) Policy Connect, CAN Mezzanine, 32-36 Loman Street, London.
Martin
M
Johnson
Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, UK.
Paula
P
McSkimming
Mundipharma International Limited, Cambridge, UK.
Sara
S
Dickerson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy; D003248:Constipation / Q000139:chemically induced* / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult
D000701:Analgesics, Opioid; D054368:Laxatives
Bowel Function Index; Chronic Pain; Laxatives; Opioid-Induced Constipation; Survey;  Opioid