What are the current standards of care or guidelines in opioid-induced constipation (OIC)?

OIC FAQs published on May 24, 2013 in Opioid-Induced Constipation (OIC)
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Jeffrey A. Gudin, MD
Director
Pain Management Center
Englewood Hospital and Medical Center
Englewood, New Jersey
This is Dr. Jeff Gudin, I am a pain management anesthesiologist and palliative care specialist at the Englewood Hospital and Medical Center in Englewood, New Jersey. I am often asked if there are any standards of care or guidelines for the treatment of opioid-induced constipation. And it turns out that this problem, although it has been recognized for decades, has really only been targeted by the pharmaceutical industry for just the past few years. We have some novel agents available to us, as you will see in our educational program, things like opioid receptor antagonists that work only out in the periphery, and even some newer agents that work by modulating ion channels at the level of the gut to draw more fluid, more water, into the intestine, stimulate motility and lubricate the stool. So although we do not have any set standards by our pain or GI societies, really what I tell clinicians is that you should try to match the appropriate therapy to the underlying disorder. So patients who take opioids obviously get what is called OIC or opioid-induced constipation. There is no one simple and easy answer. As you will see from our educational program, there are things like dietary modification, behavioral modification, activity modification, things like exercise. In addition to a host of new agents that are available, including the class of opioid receptor antagonist and chloride and ion channel activators, to again promote more flow of fluid into the bowel. When we think about opioid-induced constipation, we like to think about an overall treatment plan which incorporates not just drug therapy, but also some of those other non-drug therapies as well.
Last modified: June 7, 2013
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