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Weighing the Benefits and Side Effects of Opioids

By

Allie Lemco Toren

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This content is created or selected by the Healthgrades editorial team and is funded by an advertising sponsor. The content is subject to the Healthgrades medical review process for accuracy, balance and objectivity. The content is not edited or otherwise influenced by the advertisers appearing on this page except with the possible suggestion of the broad topic area. For more information, read the HealthGrades advertising policy.

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PHYSICIAN CONTRIBUTOR

Treatment Options for Painkiller-Induced Constipation

Farshad Ahadian, MD, recommends a variety of treatments for opioid-induced constipation.
woman-staring-at-pills-in-hands

Chronic pain affects more Americans than diabetes, cancer, and heart disease combined. And living in pain can make everything in your life harder. Over time, it can have a huge impact on your quality of life. Many people turn to over-the-counter pain relievers, but for severe pain, those may not be enough. Eventually, it might be time to turn to prescription painkillers.

Opioids are an effective and popular prescription option for relieving many types of pain—whether it’s temporary, like pain experienced after surgery or during cancer treatment, or chronic, like lingering pain from an accident or an unknown cause. According to the Mayo Clinic, about 5 to 8 million Americans use opioids for chronic pain. Opioids are a class of drugs that include oxycodone (OxyContin, Oxecta, Roxicodone), hydrocodone (Hysingla ER, Zohydro ER), codeine, morphine (Astramorph, Avinza, Kadian), fentanyl (Actiq, Duragesic, Fentora), and others. They are derived from the poppy plant and their use dates back centuries.

Opioids may bring effective pain relief, but they also come with some baggage. Unfortunately, because of how they work in the body, opioids tend to cause uncomfortable, embarrassing, and painful constipation. Experts discuss why this occurs and what patients can do to find relief.

Medical Reviewer: William C. Lloyd III, MD, FACS Last Review Date: Jul 18, 2016

2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

However, opioids aren’t a perfect fix for pain—while they do alleviate suffering, they’re accompanied by unpleasant side effects and the serious risk of addiction or abuse. When deciding if opioids are the right choice for you, make an educated decision by considering the benefits and drawbacks of these drugs.

Benefits of Opioids

Opioids, when taken as directed, can effectively help relieve all kinds of pain. Opioids work by attaching to proteins in your body called opioid receptors to reduce your perception of pain. Essentially, opioids help your body to not feel pain as intensely. Numerous studies have confirmed that opioids are effective at relieving pain for patients with cancer, low back pain, peripheral neuropathy, and other painful conditions. Relieving severe and chronic pain can improve sleep, appetite, energy levels, mood, and overall quality of life. Those suffering from chronic pain know just how life changing it can be to effectively reduce pain over the long-term.

Side Effects of Opioids

While opioids may effectively relieve pain, they come with quite a bit of drawbacks. As many as 80% of patients taking opioids experience at least one side effect. The most common side effects are gastrointestinal, like constipation, nausea, and vomiting. Side effects related to the central nervous system are also common, like impaired concentration, confusion, sleep problems, and memory problems. Opioids may also cause dry mouth, excessive sweating, weight gain, drowsiness, loss of appetite, sexual dysfunction, and dry skin.

Many of these side effects tend to go away eventually; however, opioid-induced constipation (OIC) has not been found to improve over time while you are taking an opioid. And unfortunately, constipation is considered the most common side effect of opioid use: studies have shown between 25 and 50% of patients taking opioids for long-term use develop OIC. Because of this, your doctor will most likely take proactive measures to prevent or alleviate constipation before you’ve even started taking opioids. This may mean that, along with the opioid, you’ll also take a daily stool softener or bowel stimulant. And these preventative measures should always include drinking plenty of water, exercising regularly, and eating a healthy diet. It’s important to follow your doctor’s recommendations, because although there are many over-the-counter options available to treat constipation, some of the most commonly used ones can actually make OIC worse.

Recently, several new drugs have come to the market that can relieve opioid-induced constipation. These include naloxegol (Movantik), methylnaltrexone bromide (Relistor), and lubiprostone (Amitiza). Each drug works differently to counteract the constipation often experienced with opioids. If preventative measures like stool softeners aren’t working, these new medications may offer you relief.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Jan 22, 2016

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

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Medical References

  1. Swegle, John M., Logemann, Craig. Management of Common Opioid-Induced Adverse Effects. American Family Physician. 2006 Oct 15;74(8):1347-1354. http://www.aafp.org/afp/2006/1015/p1347.html
  2. Opioids and Chronic Pain. MedlinePlus, U.S. National Library of Medicine.  https://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/articles/spring11pg9.html
  3. Pain: Hope Through Research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#3084_9
  4. Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine. http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
  5. Jamison, Robert N., Mao, Jianren. Opioid Analgesics. Mayo Clinic Proceedings. July 2015;90(7): 957-968. http://www.mayoclinicproceedings.org/article/S0025-6196(15)00342-0/fulltext
  6. Prescription Painkiller Overdoses. Centers for Disease Control and Prevention. http://www.cdc.gov/vitalsigns/pdf/2012-07-vitalsigns.pdf
  7. National Drug Threat Assessment. U.S. Department of Justice National Drug Intelligence Center. http://www.justice.gov/archive/ndic/pubs44/44849/44849p.pdf
  8. Benefits and Risks of Opioids in Arthritis Management. Johns Hopkins Arthritis Center. http://www.hopkinsarthritis.org/patient-corner/disease-management/benefits-and-risks-of-opioids-for-chronic-pain-management/
  9. Sehgal, Nalini; Colson, James; Smith, Howard S. Chronic Pain Treatment With Opioid Analgesics. Expert Reviews Neurotherapeutics. 2013;13(11):1201-1220. http://www.medscape.com/viewarticle/813875_1
  10. Rosenblum A, Parrino M, Schnoll SH, et al. Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug Alcohol Depend 2007; 90:64

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