Clinicians commonly prescribe opioids to help relieve pain their patients experience, whether it’s cancer pain, chronic pain or acute pain. What’s less common is preventive treatment for a known side effect: constipation.
A recent survey described in Clinical Pain Medicine found that about half of physicians who prescribe opioids for long-term use do not prescribe prophylaxis, or preventive treatment, for opioid-induced constipation. An estimated 3 percent of Americans take opioids for chronic pain relief, according to the journal. That means about 7.2 million adults in the United States use opioids for chronic pain.
Opioids include hydrocodone (Vicodin®), oxycodone (OxyContin®, Percocet®), morphine (Kadian®, Avinza®) and codeine. These drugs are used for different purposes: For example, morphine is for moderate to severe pain, while codeine is typically for mild pain. Opioids alleviate pain by reducing the intensity of pain signals sent to the brain.
At the same time, opioids can slow down gastrointestinal (GI) tract motility, which refers to the muscle contraction responsible for combining and pushing out the contents in the gastrointestinal tract. Slowing down GI motility can result in the feeling of incomplete bowel elimination. Bowel movements also can become infrequent and difficult.
Bowel movements and constipation are not topics people enjoy discussing. In my practice, I’ve found that patients tend not to volunteer information about constipation-related symptoms, often feeling embarrassed and uncomfortable. Clinicians must be proactive about asking patients taking opioids about constipation and other side effects, which include nausea, vomiting, itching and mental fogginess.
I’ve found that patients have an easier time talking about their symptoms if they write them down and give their notes to the clinician to start the discussion. This way, patients can be more specific and clear about what they’re experiencing, and the clinician can ask follow-up questions based on their notes.
Patients and providers need to be aware that opioid-induced constipation is a significant issue. This type of constipation among patients must be assessed and reassessed. It’s important for patients taking opioids to follow a prescribed regimen to avoid this side effect. Without a good management plan, patients may stop taking their pain medications, which can result in poorly controlled pain and affect their quality of life.
I work closely with my patients to keep the lines of communication open and to make sure they know they can share information without judgment. The sooner we can work together to get at the heart of what the patient is experiencing, the sooner we can get that patient back on the right track.
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