Conference Coverage

Constipation on opioids? Follow these three steps to ID the true cause



– To appropriately manage patients on opioids who develop constipation, one of the most important distinctions to make is whether the condition was caused by the pain treatment or was just exacerbated by it, according to Darren M. Brenner, MD.

Because of the rampant use of opioids, the answer to that question is increasingly relevant to clinical practice, said Dr. Brenner, associate professor of medicine (gastroenterology and hepatology) and surgery at Northwestern University, Chicago.

Dr. Darren M. Brenner of NOrthwestern University Feinberg School of Medicine, Chicago Andrew D. Bowser/MDedge News

Dr. Darren M. Brenner

“The key from a gastroenterologist and primary care perspective is to differentiate opioid-induced from opioid-exacerbated constipation because, realistically, treatment of the global symptom profile will provide the most effective outcomes and strategies for your patients,” Dr. Brenner said at the inaugural Perspectives in Digestive Diseases meeting held by Global Academy for Medical Education.

Dr. Brenner described a concise algorithm (Curr Gastroenterol Rep. 2017 Mar;19[3]:12) for discerning these patient groups; he codeveloped the algorithm with meeting cochair Brooks D. Cash, MD, chief of the division of gastroenterology, hepatology, and nutrition at the University of Texas, Houston.

Step 1 in the algorithm is simply to ask patients whether they are constipated. “You should ask all of your patients who are on opioids if they have this problem,” Dr. Brenner said. “A significant percentage of individuals using opioids will develop constipation.”

According to the results of studies that Dr. Brenner summarized, up to 80% of patients taking opioids for chronic, noncancer pain will develop opioid-induced constipation, and more than 90% of opioid-taking patients with advanced illness will need laxatives.

Given this prevalence, clinicians might want to be skeptical when patients on opioids reply “no” when asked whether they are constipated.

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