Treatment

Basic advice in managing constipation is to maintain high dietary fibre content and ample fluid intake. A comprehensive review of the available literature on diagnosis and management of OIC has, however, reported that there is little available evidence on the effectiveness of these actions in treating opioid-induced constipation.¹

European consensus guidelines on the management of OIC recommend that, as well as examining lifestyle factors, a review of concurrent medications should be undertaken to assess whether any of these could be exacerbating OIC. These include iron supplements, calcium channel blockers, anti-cholinergic agents, 5-Hydroxytryptamine (5-HT)3 receptor antagonists and diuretics. In some cases, switching the opioid being taken or changing the route of administration can be useful.²

Conventional first-line treatment for all types of constipation, including OIC, is laxative therapy.² Laxatives can provide relief for some OIC sufferers, but more than half of patients don’t respond satisfactorily.^3,4 

Patients and their healthcare providers may have different impressions of laxative effectiveness. In a 2016 observational study in patients with OIC, the proportion of agreement on the level of benefit and satisfaction from laxatives varied between patients and healthcare providers. Of the patients who reported "little to no benefit" of laxative treatment at baseline (n=305), 53% of their healthcare providers reported "moderate-to-complete satisfaction" with laxative treatment at baseline.⁵