Assessing and Managing Opiate-Induced Constipation in Adults with Cancer

Abstract

Cancer Control 3 pation among persons with cancer is unknown, some studies have investigated patients receiving hospice care and who are receiving active curative treatment. The range of prevalence in hospitalized patients receiving cancer treatment varies from 70% to 100%. 2-4 Studies of patients with advanced cancer who are receiving hospice care show that the prevalence of constipation ranges between 23% and 84%. 2,3,5-9 A series of studies 9-11 conducted in a large Florida hospice evaluated opiate-induced constipation and found that 40% to 64% of hospice patients with cancer have been found to have constipation. However, the number was lower when the data were obtained from a chart audit (40%) 9 and higher when the researchers prospectively interviewed patients about their symptoms (63% to 64%). 10,11 Walsh 6 found constipation to be the most common side effect of morphine among 688 hospice patients, with a prevalence of 48%. The finding of constipation is relevant because studies have shown that it is negatively related to overall quality of life (r =-.38, P<.001). 12 Defining Constipation A significant problem in assessing constipation has been the variety of definitions used by patients and healthcare providers. Some patients believe they are constipated if they do not have a bowel movement every day. Other patients expect to have only 3 bowel movements per Prevalence Limited studies of prevalence of constipation have been conducted on healthy persons and on persons with cancer. The prevalence in the general population is believed to be approximately 2%. Among the elderly in long-term care facilities, the prevalence of constipation ranges between 40% and 50%. Although the overall prevalence of consti

Effect of subcutaneous methylnaltrexone on patient-reported constipation symptoms

“…Significant improvements in rectal symptoms (including changes in painful defecation, rectal burning, and bleeding) were observed as early as Day 14 in patients treated daily with methylnaltrexone and persisted until Day 28. Activation of mu-opioid receptors increases anal sphincter tone; hence, reflexive relaxation in response to rectal distension is reduced and defecation becomes more difficult and painful [5,26,27]. Thus methylnaltrexone may be able to improve anorectal dysfunction associated with opioids and alleviate rectal symptoms as seen in the results of our study.…”

“…Increased contractions of circular muscles cause non-propulsive kneading and churning, increasing fluid absorption, which dries and hardens the stool. At the same time, longitudinal propulsive peristalsis is decreased, providing additional time for drying of the stool, ultimately resulting in reduced frequency of bowel movements, formation of hard stools, straining, incomplete evacuation of bowel, and sensation of anorectal bowel obstruction [5,27,28]. As a peripheral mu-opioid receptor antagonist, methylnaltrexone has the potential to block opioid actions mediated by peripheral opioid receptors and thus relieve the associated stool symptoms.…”

The Bowel Function Index for Evaluating Constipation in Pain Patients: Definition of a Reference Range for a Non-Constipated Population of Pain Patients

“…stool frequency), subjective measures such as straining or the feeling of incomplete bowel evacuation, must be considered. 10,24,25 The BFI takes these subjective criteria into account.…”

Pharmacological treatment of chronic pain – the need for CHANGE

“…Less frequently reported are pruritus, respiratory depression, immunological suppression and hormonal changes. All these opioid-induced side effects are a burden to both the individual and society, but their wider impact is probably underestimated by healthcare professionals 59 , despite the fact that they reduce compliance and lead to treatment discontinuations.…”