[01] Mohammed Tuffaha, Oncology Unit, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates. [02] Nezar Ahmed Salim, Oncology Unit, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates. [03] Hasan Abu Nigim, Oncology Unit, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates. [04] Mohammed Eid Al Khodary, Oncology Unit, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.

Constipation is a common problem as a result of medication (in particular opioids) for pain control, as well as disease, dietary and mobility factors, Opioids are very effective analgesics, frequently prescribed in cancer pain, despite proven analgesic efficacy, the use of opioids is commonly associated with frequently dose-limiting constipation that seriously impacts on patients’ quality of life, almost all patients on opioids report constipation as the major side-effect. Therefore this article provides an integrative review about opioid –induced constipation from all aspects with focus on the prevention. Methods: An online search of science direct data base and PubMed and Google scholar. Based on the inclusion criteria 7 articles were selected and formed the basis for this review. Conclusion: Prevention of opioid- induced constipation, in general, is considered to be a more effective strategy than merely treating it when it occurs, It is widely advised that laxatives should be started concurrently with opioids, prevention of opioid induced constipation could lead to clinical and economic benefits, Effective prevention and treatment of opioid-induced constipation can improve pain management and quality of life for patients and their families; However, limited RCTs to determine the effectiveness of prophylactic management on the prevention of opioid-induced constipation.

Opioid-Induced Constipation, Impact, Cancer, Prevention, Management

[01] Candy, B., Jones, L., Goodman, M. L., Drake, R., Tookman, A. (2011). Laxatives or methyl naltrexone for the management of constipation in palliative care patients (Review). Cochrane Database of Systematic Reviews, 8, 1-39. [02] Fredericks, A., Hollis, G., Stricker, C. T. (2010). Diagnosis and management of opioid induced bowel dysfunction in patients with advanced cancer. Clinical Journal of Oncology Nursing, 14, (6), 701-704. [03] Boland, J., Boland, E. (2017). Pharmacological therapies for opioid induced constipation in adults with cancer. BMJ; 358: j3313 doi: 10.1136/bmj. j3313 (Published 2017 August 02). [04] Reimer K, Hopp M, Zenz M, et al. Meeting the challenges of opioid-induced constipation in chronic pain management—a novel approach. Pharmacology 2009; 83: 10-17. [05] Bouvy, M. L., Buurma, H., Egberts, T. C. G. (2002). Laxative prescribing in relation to opioid use and the influence of pharmacy-based intervention. Journal of Clinical Pharmacy and Therapeutics, 27, 107-110. [06] De Luca, A, and Coupar, IM (1996). Insights into opioid action in the intestinal tract. Pharmacology & therapeutics 69, 103-15. [07] De Schepper, HU, Cremonini, F, Park, MI, et al. (2004). Opioids and the gut: pharmacology and current clinical experience. Neurogastroenterol Motil 16, 383-94. [08] Holzer, P. (2004). Opioids and opioid receptors in the enteric nervous system: from a problem in opioid analgesia to a possible new prokinetic therapy in humans. Neuroscience letters 361, 192-5. [09] Holzer, P. (2007). Treatment of opioid-induced gut dysfunction. Expert opinion on investigational drugs 16, 181-94. [10] Mehendale, SR, and Yuan, CS (2006). Opioid-induced gastrointestinal dysfunction. Dig Dis 24, 105-12. [11] Wood, JD, and Galligan, JJ (2004). Function of opioids in the enteric nervous system. Neurogastroenterol Motil. 16, 17-28. [12] Panchal, SJ, Muller-Schwefe, P, and Wurzelmann, JI (2007). Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden. Int J Clin Pract 61, 1181-7. [13] Webster, L. (2015). Opioid-Induced Constipation. Pain Medicine, 16: S16-S21. [14] Stevens, A. M., Droney, J., Riley, J. (2008). Managing and treating opioid-induced constipation in patients with cancer. gastrointestinal nursing, 6, (9), 16-22. [15] Amir Rumman, Zane R. Gallinger & Louis W. C. Liu (2016) Opioid induced constipation in cancer patients: pathophysiology, diagnosis and treatment, Expert Review of Quality of Life in Cancer Care, 1:1, 25-35, DOI: 10.1080/23809000.2016.1131595. [16] Dhingra L, Shuk E, Grossman B, et al. A qualitative study to explore psychological distress and illness burden associated with opioid-induced constipation in cancer patients with advanced disease. Palliat Med. 2013; 27: 447-456. [17] Candrilli, S. D., Davis, K. L., Iyer, S. (2009). Impact of Constipation on Opioid Use Patterns, Health Care Resource Utilization, and Costs in Cancer Patients on Opioid Therapy. Journal of Pain & Palliative Care Pharmacotherapy, 23, (3), 231-241. [18] Klepstad P, Borchgrevink PC, Kaasa S. Effects on cancer patients’ health-related quality of life after the start of morphine therapy. J Pain Symptom Manage 2000; 20: 19-26. [19] Devulder J, Richarz U, Nataraja SH. Impact of long-term use of opioids on quality of life in patients with chronic, non-malignant pain. Curr Med Res Opin 2005; 21: 1555-68. [20] Bell, T., Milanova, T., Grove, G., Williamson, R., Bolge, S. (2007). OBD symptoms impair quality of life and daily activities, regardless of frequency and duration of opioid treatment: results of a US patient survey (PROBE survey). The journal of pain, 8, (4), 71. [21] Leslie J, Bell T, Annunziata K, Freedman D. Opioid-induced constipation compromises pain management and impacts patients quality of life. Anesthesiology 2006; 105: A1490. http://www.kantarhealth.com/docs/publications-citations/iasp-06-opioid-constipation.pdf Accessed December 15, 2013. [22] Bell, T, Annunziata, K, and Leslie, JB (2009). Opioid-induced constipation negatively impacts pain management, productivity, and health-related quality of life: findings from the National Health and Wellness Survey. J Opioid Manag 5, 137-44. [23] Hjalte, F., Berggren, A., Bergendahl, H., Hjortsberg, C. (2010). The Direct and Indirect Costs of Opioid-Induced Constipation. Journal of Pain and Symptom Management, 40, (5), 696-703. [24] Wee, B., Adams, A., Thompson, K., Percival, F., Burslem, K., Jobanputra, M. (2010). How Much Does It Cost a Specialist Palliative Care Unit to Manage Constipation in Patients Receiving Opioid Therapy? Journal of Pain and Symptom Management, 39, (4), 644-65. [25] Takemoto, M. L. S., Fernandes, R. A., Almeida, G. R., Monteiro, R. D. C., Colombini-Neto, M., Bertola-Neto, A. (2011). Health Care Resource Use and Costs in Opioid-Treated Patients with and without Constipation in Brazil. Value in health, 14, (5), 78-81.