Opioid-Induced Constipation

Opioid-induced constipation (OIC) is common in people treated with opioids and poses risks for physical sequelae, analgesic discontinuation, and decreased quality of life.

Targeted literature review of evidence- and consensus-based data on appropriate diagnosis, concise definition, and conventional and newer management strategies for OIC.

OIC may develop early and need early treatment. To address gaps in consistent definitions and treatment recommendations, a consensus panel organized through the American Academy of Pain Medicine Foundation set diagnostic criteria and endorsed the Bowel Function Index for OIC assessment. The panel further proposed management strategies for OIC, including a proposed threshold for prescriptive therapies.

OIC results from action exerted on opioid receptors in the gastrointestinal tract, a mechanism distinct from idiopathic constipation. Lifestyle changes and over-the-counter drugs are first-line treatments but leave refractory constipation in many opioid-treated patients. Newer therapeutic modalities that are available and in development are highlighted.

Physicians need a better understanding of the negative impacts of OIC for patients and better OIC-specific methods to assess, treat, and monitor it.