Opioids and GI Motility—Friend or Foe?

Opinion statement

The use of opioids for the treatment of chronic non-cancer pain is growing at an alarming rate. Opioid-induced bowel dysfunction (OBD) is a common adverse effect of long-term opioid treatment manifesting as constipation, nausea, and vomiting. These effects are primarily mediated by peripheral μ-opioid receptors with resultant altered GI motility and function. As a result, patients may present with opioid-induced constipation (OIC), opioid-induced nausea and vomiting (OINV), and/or narcotic bowel syndrome (NBS). This often leads to decreased quality of life and in many cases, discontinuation of opioid therapy. There is limited evidence to support the use of traditional anti-emetics and laxatives in the treatment of OBD. Tapering the dose of opioids, switching to transdermal application, opioid rotation, or dual-action opioids, such as tapentadol, may be helpful in the treatment of OBD. Novel agents, such as peripherally acting μ-opioid receptor antagonists which target the cause of OIC, show promise in the treatment of OBD and should be considered when conventional laxatives fail. This chapter will review the pathophysiology of OBD, including OINV and OIC, and treatment options available.

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Correspondence to William L. Hasler MD.

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Conflict of Interest

Allen A. Lee declares no conflict of interest. William L. Hasler has received grant support from Medtronic, Inc. (manufacturer of SmartPill) and has served as a consultant with Allergan, Plc. and Rhythm Pharmaceuticals, Inc. (regarding potential use of relamorelin in gastroparesis).

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Motility

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Lee, A.A., Hasler, W.L. Opioids and GI Motility—Friend or Foe?. Curr Treat Options Gastro 14, 478–494 (2016). https://doi.org/10.1007/s11938-016-0112-0

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Keywords

  • Opioids
  • Opioid-induced bowel dysfunction
  • Opioid-induced constipation
  • Opioid-induced nausea and vomiting
  • Narcotic bowel syndrome
  • Peripherally acting μ-opioid receptor antagonists