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Opioid-induced bowel dysfunction: suggestions from a multidisciplinary expert Board.

Marco Rossi1, Giuseppe Casale2, Danilo Badiali3

  • 1Department of Anaesthesia and Emergency Medicine-IRCCS Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy. marco.rossi1@unicatt.it.

Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
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Summary

Opioid-induced bowel dysfunction (OIBD) significantly impacts patient quality of life, especially in advanced cancer and chronic pain patients. This expert opinion offers recommendations for early, multidisciplinary management to improve adherence to pain therapy.

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ConstipationMu receptorMultidisciplinaryOpioidsPain

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Area of Science:

  • Pain Management
  • Gastroenterology
  • Oncology

Background:

  • Opioid-induced bowel dysfunction (OIBD) is a common, yet often overlooked, adverse effect of opioid therapy.
  • It significantly diminishes the quality of life for cancer patients with advanced disease and non-cancer patients on chronic opioid treatment.
  • Awareness and consistent management strategies among healthcare providers remain insufficient despite existing guidelines.

Purpose of the Study:

  • To provide an expert opinion on managing OIBD, addressing unmet needs in cancer and non-cancer patients.
  • To examine key issues including OIBD definition, early intervention benefits, and the role of peripherally acting mu-opioid receptor antagonists (PAMORAs).
  • To propose practical recommendations and algorithms for daily clinical practice.

Main Methods:

  • Convened a multidisciplinary expert Board of Italian specialists in pain management, oncology, palliative care, and gastroenterology.
  • Reviewed current literature, focusing on the recently introduced PAMORA, naloxegol.
  • Examined unresolved issues in OIBD management and developed consensus-based recommendations.

Main Results:

  • The expert Board addressed critical aspects of OIBD, including its definition and the importance of early intervention.
  • Recommendations were formulated for the appropriate use of PAMORAs, such as naloxegol.
  • Procedural algorithms were developed for practical, multidisciplinary application in clinical settings.

Conclusions:

  • A multidisciplinary, early-intervention approach to OIBD is crucial for managing patients on opioid therapy.
  • Implementing evidence-based recommendations and practical tools can improve patient adherence to pain management and enhance quality of life.
  • Collaboration between specialists, general practitioners, and caregivers is vital for optimal OIBD patient care.