Opioid-induced constipation: a narrative review of therapeutic options in clinical management.

Opioid-induced constipation: a narrative review of therapeutic options in clinical management. Korean J Pain. 2019 Apr 01;32(2):69-78 Authors: Lang-Illievich K, Bornemann-Cimenti H Abstract Pain therapy often entails gastrointestinal adverse events. While opioids are effective drugs for pain relief, the incidence of opioid-induced constipation (OIC) varies greatly from 15% to as high as 81%. This can lead to a significant impairment in quality of life, often resulting in discontinuation of opioid therapy. In this regard, a good doctor-patient relationship is especially pivotal when initiating opioid therapy. In addition to a detailed history of bowel habits, patient education regarding the possible gastrointestinal side effects of the drugs is crucial. In addition, the bowel function must be regularly evaluated for the entire duration of treatment with opioids. Furthermore, if the patient has preexisting constipation that is well under control, continuation of that treatment is important. In the absence of such history, general recommendations should include sufficient fluid intake, physical activity, and regular intake of dietary fiber. In patients of OIC with ongoing opioid therapy, the necessity of opioid use should be critically reevaluated in terms of an with acceptable quality of life, particularly in cases of non-cancer pain. If opioids must be continued, lowering the dose may help, as well as changing the type of opioid. If these measures do not s...
Source: Korean Journal of Pain - Category: Anesthesiology Tags: Korean J Pain Source Type: research

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We appreciate the response of Clark et  al. to our article, Challenges in Recruiting Patients to a Controlled Feasibility Study of a Drug for Opioid-Induced Constipation: Lessons From the Population With Advanced Cancer (JPSM 2019;57(5):e5-e8), and their extensive experience from the Australian Palliative Care Outcomes Collaboration. A lthough we agree that distress from constipation may be limited to a small percentage of the cancer population and contribute to recruitment challenges, other factors we encountered included late referrals, rapid trajectory of disease, limited opioid use, and disinterest because of...
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Tags: Letter Source Type: research
We were most interested to read the letter by Bull et  al.1 As researchers, clinicians and academics in supportive and palliative care, the letter resonated with our own experiences when trying to recruit to studies exploring the problems of disordered bowel function in patients with advanced cancer. Although the authors of the published letter attrib ute this to the advanced cancer population, we would like to suggest an alternative opinion. In contrast, we submit that rather than this being an issue with the advanced illness stage of this patient cohort, the problems were related to the symptom they were investigating: constipation.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Tags: Letter Source Type: research
AbstractIntroductionSublingual fentanyl tablets (SFTs) have been shown to be a safe and effective option in controlling breakthrough cancer pain (BTcP). However, further examination is required to investigate the use of SFTs among the elderly. The aim of this study was to examine the influence of age in BTcP management with SFTs in the elderly population.MethodsWe performed subgroup analyses of a recently completed trial in two subsets of individuals: patients aged 65 –74 years (low age group) and patients ≥ 75 years (high age group). Pain intensity (PI), onset of pain relief, frequency and...
Source: Drugs in R&D - Category: Drugs & Pharmacology Source Type: research
This study was carried out in accordance with approval of the Melbourne Health and Walter and Eliza Hall Institute of Medical Research's Human Research Ethics Committee (approval number: 2013.081). All subjects gave written informed consent for participation and publication. Results and Discussion TGF-β signaling in NK cells is associated with: phosphorylation in SMAD2 and 3, inhibition of IL-15-induced metabolism/proliferation, simultaneous downregulation of CD44, CD49e, and Eomes, and upregulation of CD16 and CD49a expression (7, 10). SMAD family member 4 (SMAD4) belongs to the SMAD family of transcription...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Conclusions: This study demonstrated a rapid improvement of many symptoms in the subacute post-operative period in pituitary tumor patients. Disturbed sleep was identified as the only symptom to worsen post-operatively, encouraging potential prospective interventions to improve sleep, and subsequently improve the QOL in pituitary tumor patients following surgical intervention. Introduction Pituitary tumors are relatively rare primary central nervous system (CNS) tumors in adults (1) but make up 10% of all neurosurgical interventions in the United States (2). They are often an incidental finding in autopsies and brain...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
DiscussionRecent evidence suggests that intravenous lidocaine can lead to opioid sparing and chronic postsurgical pain reduction for certain types of surgery. This is the first trial to prospectively investigate the efficacy and safety of intravenous lidocaine in major head and neck cancer surgery.Trial registrationClinicalTrials.gov,NCT02894710. Registered on 11 August 2016.
Source: Trials - Category: Research Source Type: clinical trials
ConclusionsA suspicious attitude towards cancer-related symptoms during pregnancy is crucial to prevent delayed evaluation for CRC.
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
Clinical research is difficult in populations with advanced illness because patients have a high disease burden and short life expectancy, poor functional status and high distress, or an unpredictable course characterized by changing therapies and an increased risk of adverse events. This is reflected in the paucity of published trials; fewer than 1% are conducted in an advanced illness population. The lack of randomized trials means that high-quality evidence plays a small role in defining best clinical practices and standards for end-of-life care 1.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
Coming in to meet the students, housestaff and patients for the first day on service always excites me. This Monday was no exception. What awaited me? How many patients would I need to see? What lessons could I impart? When I arrived we had 11 patients, 2 new and 9 had arrived previously. Going through the list, while routine, always stimulated questions and teaching opportunities. Sometimes the team had questions for me. Sometimes they had a mischievous sense of putting me on the spot. I always love that interplay. When we got to the man in 558, they told a sad story of an angry man with terminal cancer. He had acce...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs
Subcutaneous (SC) methylnaltrexone is approved for opioid-induced constipation (OIC) in adults with chronic non-cancer pain and OIC in adults with advanced illness or with active cancer who require opioid dosage escalation for palliative care.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
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