Opioid-induced bowel dysfunction in cancer-related pain: Causes, consequences, and a novel approach for its management

Peter Holzer, PhD; Sam H. Ahmedzai, BSc, MBChB, FRCP; Norbert Niederle, MD; Petra Leyendecker, PhD; Michael Hopp, MD; Björn Bosse, Statistics (Diploma); Ingrid Spohr, PhD; Karen Reimer, MD

doi:10.5055/jom.2009.0015

Authors

Peter Holzer, PhD
Sam H. Ahmedzai, BSc, MBChB, FRCP
Norbert Niederle, MD
Petra Leyendecker, PhD
Michael Hopp, MD
Björn Bosse, Statistics (Diploma)
Ingrid Spohr, PhD
Karen Reimer, MD

DOI:

https://doi.org/10.5055/jom.2009.0015

Keywords:

cancer, constipation, naloxone, opioid, oxycodone, pain

Abstract

Opioids are the mainstay of management for patients with cancer-related pain. Although the analgesic efficacy of opioid therapy is well documented, the recent European Pain in Cancer survey demonstrated that the management of moderate-to-severe pain in patients with cancer is far from optimal. Bowel dysfunction, and importantly constipation, is a common side effect and has a significant impact on the patient’s morbidity and quality of life. Nonpharmacological strategies and laxatives are often not effective in the management of opioid-induced constipation (OIC), making it necessary to search for new strategies for the treatment of opioid-induced bowel dysfunction. One promising strategy is the prevention of OIC with peripherally acting opioid antagonists that specifically target the underlying cause of this condition, without affecting centrally mediated analgesia. In recent studies, the novel combination of prolonged-release oral oxycodone and prolonged-release oral naloxone provided effective analgesia with improved bowel function in patients suffering from severe cancer-related and noncancer-related pain. The combination has the potential to improve the quality of pain management significantly in these patients.

Author Biographies

Peter Holzer, PhD

Institut für Experimentelle und Klinische Pharmakologie, Medizinische Universität Graz, Graz, Austria.

Sam H. Ahmedzai, BSc, MBChB, FRCP

Academic Unit of Supportive Care, Section of Oncology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom.

Norbert Niederle, MD

Klinikum Leverkusen GmbH, Medizinische Klinik III, Leverkusen, Germany.

Petra Leyendecker, PhD

Mundipharma Research GmbH & Co. KG, Limburg (Lahn), Germany.

Michael Hopp, MD

Mundipharma Research GmbH & Co. KG, Limburg (Lahn), Germany.

Björn Bosse, Statistics (Diploma)

Mundipharma Research GmbH & Co. KG, Limburg (Lahn), Germany.

Ingrid Spohr, PhD

Mundipharma GmbH, Limburg (Lahn), Germany.

Karen Reimer, MD

Mundipharma Research GmbH & Co. KG, Limburg (Lahn), Germany; University Witten/Herdecke, Witten, Germany.

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