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Definition, diagnos...
Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction-Recommendations of the Nordic Working Group
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- Drewes, A. M. (author)
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark,Nordic Working Group
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- Munkholm, P. (author)
- NOH (Nordsjællands Hospital) Gastroenterology, Denmark,Nordic Working Group
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- Simrén, Magnus, 1966 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition,Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Nordic Working Group
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- Breivik, H. (author)
- Department of Pain Management and Research, Oslo University Hospital and University of Oslo, Norway,Nordic Working Group
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- Kongsgaard, U. E. (author)
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Norway and Medical Faculty, University of Oslo, Norway,Nordic Working Group
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- Hatlebakk, J. (author)
- Department of Clinical Medicine, Haukeland University Hospital, Bergen, Norway,Nordic Working Group
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- Agreus, L. (author)
- Karolinska Institutet
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- Friedrichsen, Maria, 1966- (author)
- Linköpings universitet,Medicinska fakulteten,Avdelningen för omvårdnad,Region Östergötland, Palliativt kompetenscentrum,Nordic Working Group
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- Christrup, L. L. (author)
- Department of Drug Design and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Denmark,Nordic Working Group
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(creator_code:org_t)
- 2016-04-01
- 2016
- English.
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In: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 11, s. 111-122
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Abstract
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- 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 receive 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 and should also be considered in this context. There are no available tools to assess OIBD, but many rating scales have been developed to assess constipation, and a few specifically address OIC. A clinical treatment strategy for OIBD/OIC was proposed and presented in a flowchart. First-line treatment of OIC is conventional laxatives, lifestyle changes, tapering the opioid dosage and alternative analgesics. Whilst opioid rotation may also improve symptoms, these remain unalleviated in a substantial proportion of patients. Should conventional treatment fail, mechanism-based treatment with opioid antagonists should be considered, and they show advantages over laxatives. It should not be overlooked that many reasons for constipation other than OIBD exist, which should be taken into consideration in the individual patient. Conclusion and implications: It is the belief of this Nordic Working Group that increased awareness of adverse effects and OIBD, particularly OIC, will lead to better pain treatment in patients on opioid therapy. Subsequently, optimised therapy will improve quality of life and, from a socio-economic perspective, may also reduce costs associated with hospitalisation, sick leave and early retirement in these patients.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Gastroenterologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
Keyword
- Opioids
- Pain
- Adverse effects
- Constipation
- Antagonists
- Treatment strategies
- chronic noncancer pain
- prolonged-release oxycodone/naloxone
- randomized-controlled-trials
- lower esophageal sphincter
- internal
- anal-sphincter
- population-based survey
- quality-of-life
- induced
- constipation
- double-blind
- cancer-patients
- opioid induced constipation; treatment; diagnosis
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Drewes, A. M.
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Munkholm, P.
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Simrén, Magnus, ...
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Breivik, H.
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Kongsgaard, U. E ...
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Hatlebakk, J.
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Agreus, L.
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Friedrichsen, Ma ...
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Christrup, L. L.
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Gastroenterology ...
- Articles in the publication
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Scandinavian Jou ...
- By the university
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University of Gothenburg
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Linköping University
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Karolinska Institutet