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How Can You Manage Opioid-Induced Constipation?

One drawback of narcotics for pain relief is opioid-induced constipation. Several drugs may help counteract this complication.
How Can You Manage Opioid-Induced Constipation?
Suffering from constipation male sitting on toilet, health care, strong pain

Opioids have gotten a bad name over the last several years because so many users have overdosed and died. But people have been using these drugs, also known as narcotics, for millennia. The ancient Assyrians, Sumerians and Egyptians all recognized the power of the opium poppy to ease pain. Modern medicine uses synthetic analogs and derivatives of natural opioids for people whose cancer pain would be unbearable otherwise. Used properly, they can make a tremendous difference–if you can manage the side effect of opioid-induced constipation.

Cancer is not the only painful condition for which opioids help make each day livable.

Opioids for Pain Relief:

We have heard from many readers like this one:

“I have been a chronic care disabled patient after a five-car pile-up left me severely injured. After 15 years of procedures, I was told I would be on pain meds the rest of my life by a neurosurgeon who is the best in my state!

“I attempted several times to detox with professional help and went through withdrawal only to get put back on my pain meds because I had a child to raise alone and could not get out of bed to care for her due to my pain.”

Opioid-Induced Constipation:

Between 40 and 60 percent of those who take opioid pain relievers suffer constipation (StatPearls, Jan. 2020). The standard constipation fighters, fiber and fluids, may not be enough to manage this kind of bowel problem. 

One reader shared his experience:

“I’m two weeks out of the hospital from knee replacement. The pain of the opioid-caused constipation was worse than the knee, and I refused to leave the hospital until I was helped to gain control. The protocol to prevent binding was not adequate at all so I was caught off guard. (There was no fiber in the hospital diet except sugary cereals.)”

Health professionals often recommend fiber, increased fluids, exercise and laxatives to treat opioid-induced constipation (OIC). Experts suggest that laxatives such as senna and bisacodyl,  should be given along with the opioid.  However, patients don’t always find laxatives helpful for this problem (Pain Medicine, Oct. 1, 2017). On the other hand, physicians can prescribe prescription medications designed to ease this common complaint.

Drugs to Treat Opioid-Induced Constipation:

The FDA approved naloxegol (Movantik) in 2014 to overcome OIC due to drugs such as hydrocodone or oxycodone. Since then, drug companies have developed other medications for this problem.

They include methylnaltrexone (Relistor) and naldemedine (Symproic). All of these medications work by counteracting opioid activity within the digestive tract. While these drugs can help, they are far from perfect. They perform best in combination with the non-drug approaches described above.

Side Effects of Medications to Counteract Constipation:

Side effects can include abdominal pain. With serious pain, people should discontinue the drug and get medical attention promptly. GI perforation is a rare but very serious complication. Other adverse reactions include nausea, diarrhea and rash.

Here is one reader’s report:

“I’ve been taking Movantik for about a month now and I love it. It is the only thing that has helped my OIC. Other laxatives do not work and Miralax makes me nauseated.

“I started off by taking it as needed at bedtime and have always been relieved first thing in the morning. I’m starting to take it daily now to see how it goes.”

Doctors have one other prescription option that works differently from naloxegol, methylnaltrexone or naldemedine. Lubiprostone (Amitiza) encourages the digestive tract to accumulate fluid that can soften stool and move it along. Lubiprostone can improve bowel movements modestly for people with opioid-induced constipation (United European Gastroenterology Journal, Feb. 2019).

In summary, opioids remain valuable tools against intolerable pain. Cancer patients as well as other people who require chronic pain medicines need all the help they can get. 

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
  • Sizar O et al, "Opioid induced constipation." StatPearls, Jan. 2020.
  • Emmanuel A et al, "Laxatives do not improve symptoms of opioid-induced constipation: Results of a patient survey." Pain Medicine, Oct. 1, 2017. DOI: 10.1093/pm/pnw24
  • Farmer AD et al, "Pathophysiology and management of opioid-induced constipation: European expert consensus statement." United European Gastroenterology Journal, Feb. 2019. DOI: 10.1177/2050640618818305
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