Laxatives do not improve symptoms of opioid-induced constipation: results of a patient survey

Emmanuel, A., Johnson, M. and McSkimming, P. (2017) Laxatives do not improve symptoms of opioid-induced constipation: results of a patient survey. Pain Medicine, 18(10), pp. 1932-1940. (doi: 10.1093/pm/pnw240) (PMID:28339544)

Abstract

Introduction: Laxatives are commonly used to treat opioid-induced constipation, the commonest and most bothersome complication of opioids. However, laxatives have a non-specific action and do not target underlying mechanisms of opioid-induced constipation; their use is associated with abdominal symptoms that negatively impact quality of life. Objective: To assess the effects of laxatives in patients taking opioids for chronic pain. Methods: 198 UK patients who had taken opioid analgesics for at least one month completed a cross-sectional online or telephone survey. Questions addressed their pain condition and medication, and laxative use (including efficacy and side-effects). The survey also assessed bowel function using the Bowel Function Index. Results: Since starting their current opioid, 134/184 patients (73%) had used laxatives at some point and 122 (91%) of these were currently taking them. The most common laxatives were osmotics and stimulants. Laxative side-effects were reported in 75%, most commonly gas, bloating/fullness and a sudden urge to defecate. Side-effects were more common in patients <40 years old. Approximately half of patients said laxatives interfered with work and social activities, and one-fifth had needed an overnight hospital stay because of their pain condition and/or constipation. Laxatives did not improve the symptoms of constipation, as assessed by the Bowel Function Index. Constipation was not related to opioid strength or dose of opioid or number of laxatives taken. Conclusions: Use of laxatives to treat opioid-induced constipation is often ineffective and associated with side-effects. Instead of relieving the burden of opioid-induced constipation, laxative use is associated with a negative impact.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mcskimming, Mrs Paula
• Authors: Emmanuel, A., Johnson, M., and McSkimming, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Pain Medicine
• Publisher: Oxford University Press
• ISSN: 1526-2375
• ISSN (Online): 1526-4637
• Published Online: 10 October 2016
• Copyright Holders: Copyright © 2016 American Academy of Pain Medicine.
• First Published: First published in Pain Medicine 18(10):1932-1940
• Publisher Policy: Reproduced under a Creative Commons License