Overview

Opioid-induced constipation (OIC) refers to a spectrum of disorders that develop secondary to the actions of opioid analgesics on the gastrointestinal (GI) tract and the central nervous system.1 Patients with OIC meet the criteria for functional constipation with the additional criterion of a change from baseline in bowel habits when initiating, changing, or increasing opioid therapy.2 This change is characterized by reduced bowel frequency, development or worsening of straining, a sense of incomplete evacuation, or patient perception of distress related to their bowel habits.1,3

Incidence of OIC in patients taking opioid analgesics

Infographics of the incidence of OIC in noncancer and cancer pain Infographics of the incidence of OIC in noncancer and cancer pain

Medical Unmet Need in OIC – Patients With Noncancer Pain

Medical ummet need in OIC in noncancer pain infographic Medical ummet need in OIC in noncancer pain infographic

OTC, over the counter.

*Population-based survey of US adults with noncaner pain (n=2055).

†Survey conducted by PainPathways Magazine (September–November 2014 and December 2014–February 2015) in 489 patients with OIC.

Sources: *Cook SF, et al. Aliment Pharmacol Ther. 2008;27(12):1224-1232 . †Rauck RL, et al. Pain Pract. 2016;17(3):329-335.

Medical Unmet Need in OIC – Patients With Cancer Pain

Medical unmet need in OIC in cancer pain infographic Medical unmet need in OIC in cancer pain infographic

‡Cross-sectional study of patients with cancer pain conducted in France (June 2009–June 2010; n=520)

Source: Abramowitz L, et al. J Med Econ. 2013;16(12):1423-1433.

Pathophysiology of OIC

OIC is a generally well-understood consequence of opioid signaling both peripherally and centrally.4 Opioids activate mu (μ)-opioid receptors in the stomach and intestines, which inhibit the neural pathways responsible for peristalsis and colonic transit.4 In addition, μ-opioid activation increases fluid absorption from the intestines.5

Chronic opioid use is known to induce tolerance, requiring more drug to have the same effect. In the GI tract, opioid tolerance differs depending on the region—in the colon, tolerance is largely absent. Thus, OIC does not usually resolve over time.5

VIEW CONGRESS MATERIALS AND JOURNAL ARTICLES ON OIC.

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References

  1. Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology. 2016;150(6):1393-1407.

  2. Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol. 2020;14(1):39-46.

  3. Camilleri M, Ford AC, Mawe GM, et al. Chronic constipation. Nat Rev Dis Primers. 2017;3:17095.

  4. Sharma A, Rao SSC, Kearns K, Orleck KD, Waldman SA. Review article: diagnosis, management and patient perspectives of the spectrum of constipation disorders. Aliment Pharmacol Ther. 2021;53(12):1250-1267.

  5. Camilleri M, Lembo A, Katzka DA. Opioids in gastroenterology: treating adverse effects and creating therapeutic benefits. Clin Gastroenterol Hepatol. 2017;15(9):1338-1349.

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