Constipation in people prescribed opioids
Constipation is infrequent defecation with increased difficulty or discomfort and with reduced number of bowel movements, which may or may not be abnormally hard. It can have many causes, one of which is opioid use. Opioid-induced bowel dysfunction (OBD) encompasses a wide range of associated symptoms including abdominal distension and pain, gastric fullness, nausea, vomiting, anorexia, confusion, and overflow diarrhoea. These symptoms may also be associated with constipation from other causes. This review focuses only on constipation in people prescribed opioids. For the purposes of this review, we have used the UK National Institute for Health and Clinical Excellence definition of supportive care as follows: supportive care "helps the patient and their family to cope with cancer and treatment of it — from pre-diagnosis, through the process of diagnosis and treatment, to cure, continuing illness or death and into bereavement. It helps the patient to maximise the benefits of treatment and to live as well as possible with the effects of the disease. It is given equal priority alongside diagnosis and treatment". This definition was written in relation to people with cancer but is applicable to all people with chronic or terminal illness; for example, heart failure or lung disease. We have used the WHO definition of palliative care as follows: "Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual". Although this definition of palliative care does not specify incurable or terminal illness, there is consensus that palliative care applies to people approaching the end of life; that is, people with a prognosis of less than 1 year. Thus, both supportive and palliative care embrace the same priorities of maximising quality of life; but supportive care aims to do this in people who may live longer, become cured, or who are living in remission from their disease.
Laxatives for the management of constipation in palliative care patients. ( 17 August 2015 )
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