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:
Q. I had back surgery several days ago. The surgeon prescribed oxycodone to help with the pain. As a result, I have experienced severe constipation. Since returning home from the hospital, I have not had a bowel movement.
I tried MiraLax but it has not helped. Is there anything else that could ease my discomfort?
A. Opioid-induced constipation can be a serious problem. Doctors have a few prescription options for this problem, though. Medications that counteract the action of opioids within the digestive tract include naloxegol (Movantik), methylnaltrexone (Relistor) and naldemedine (Symproic).
Your physician might prescribe you one of these until you no longer need the oxycodone. Fiber and fluids are also essential.
Unfortunately, these drugs are quite pricey. We don’t know if your insurance will cover the cost. In addition, side effects may include nausea, diarrhea and abdominal pain.
Another reader requires chronic opioid medications because of severe chronic pain:
“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.
