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Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction—: Recommendations of the Nordic Working Group
Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark. (Nordic Working Group)
NOH (Nordsjællands Hospital) Gastroenterology, Denmark. (Nordic Working Group)
Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden. (Nordic Working Group)
Department of Pain Management and Research, Oslo University Hospital and University of Oslo, Norway. (Nordic Working Group)
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2016 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 11, 111-122 p.Article, review/survey (Refereed) Published
Abstract [en]

Background and aims: Opioid-induced bowel dysfunction (OIBD) is an increasing problem due to the common use of opioids for pain worldwide. It manifests with different symptoms, such as dry mouth,gastro-oesophageal reflux, vomiting, bloating, abdominal pain, anorexia, hard stools, constipation and incomplete evacuation. Opioid-induced constipation (OIC) is one of its many symptoms and probably the most prevalent. The current review describes the pathophysiology, clinical implications, and treatment of OIBD.Methods: The Nordic Working Group was formed to provide input for Scandinavian specialists in multiple, relevant areas. Seven main topics with associated statements were defined. The working plan provided a structured format for systematic reviews and included instructions on how to evaluate the level of evidence according to the GRADE guidelines. The quality of evidence supporting the different statements was rated as high, moderate or low. At a second meeting, the group discussed and voted on each section with recommendations (weak and strong) for the statements.Results: The literature review supported the fact that opioid receptors are expressed throughout the gastrointestinal tract. When blocked by exogenous opioids, there are changes in motility, secretion and absorption of fluids, and sphincter function that are reflected in clinical symptoms. The group supported a recent consensus statement for OIC, which takes into account the change in bowel habits for at least one week rather than focusing on the frequency of bowel movements. Many patients with pain received opioid therapy and concomitant constipation is associated with increased morbidity and utilization of healthcare resources. Opioid treatment for acute postoperative pain will prolong the postoperative ileus.

Place, publisher, year, edition, pages
Elsevier, 2016. Vol. 11, 111-122 p.
Keyword [en]
opioid induced constipation; treatment; diagnosis
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:liu:diva-125722DOI: 10.1016/j.sjpain.2015.12.005OAI: oai:DiVA.org:liu-125722DiVA: diva2:907960
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AstraZeneca
Available from: 2016-03-01 Created: 2016-03-01 Last updated: 2017-05-08

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