, Volume 72, Issue 14, pp 1847–1865 | Cite as

Opioid-Induced Bowel Dysfunction

Pathophysiology and Management
  • Christina BrockEmail author
  • Søren Schou Olesen
  • Anne Estrup Olesen
  • Jens Brøndum Frøkjaer
  • Trine Andresen
  • Asbjørn Mohr Drewes
Review Article


Opioids are the most commonly prescribed medications to treat severe pain in the Western world. It has been estimated that up to 90% of American patients presenting to specialized pain centres are treated with opioids. Along with their analgesic properties, opioids have the potential to produce substantial side effects, such as nausea, cognitive impairment, addiction and urinary retention. In the gut, opioids exert their action on the enteric nervous system, where they bind to the myenteric and submucosal plexuses, causing dysmotility, decreased fluid secretion and sphincter dysfunction, which all leads to opioid-induced bowel dysfunction (OIBD). In the clinic, this is reported as nausea, vomiting, gastro-oesophageal reflux-related symptoms, constipation, etc.

One of the most severe symptoms is constipation, which can be assessed using different scales for subjective assessment. Objective methods such as radiography and colonic transit time can also be used, together with manometry and evaluation of anorectal function to explore the pathophysiology.

Dose-limiting adverse symptoms of OIBD can lead to insufficient pain treatment. Even though several treatment strategies are available, the side effects are still a major challenge. Traditional laxatives are normally prescribed but they are often insufficient to alleviate symptoms, especially those from the upper gastrointestinal tract. Newer prokinetics, such as prucalopride and lubiprostone, may be more effective in alleviating OIBD. Another treatment approach is co-administration of opioid antagonists, which either cannot cross the blood-brain barrier or selectively target opioid receptors in the gastrointestinal tract. However, although these new agents have proved to be more efficacious than placebo, clinical trials still need to prove their superiority to standard co-prescribed laxative regimes.


Constipation Oxycodone Enteric Nervous System Tapentadol Colonic Transit Time 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are indebted to Matias Nilsson, who created or adapted all the illustrations for this manuscript.

The research at Aalborg Hospital leading to this systematic review received funding from the Danish Agency for Science, Technology and Innovation: Det Strategiske Forskningsråd; grant No.10-092786 and Det Obelske Familie Fond.

Anne Estrup Olesen has received honoraria from Norpharma, Denmark. Asbjørn M. Drewes has received unrestricted research grants from Mundipharma, AstraZeneca, Lundbeck and Pfizer, and has served as a consultant/on an advisory board for Mundipharma, Shire and AstraZeneca.


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Copyright information

© Springer International Publishing AG 2012

Authors and Affiliations

  • Christina Brock
    • 1
    Email author
  • Søren Schou Olesen
    • 1
  • Anne Estrup Olesen
    • 1
  • Jens Brøndum Frøkjaer
    • 1
    • 2
  • Trine Andresen
    • 1
  • Asbjørn Mohr Drewes
    • 1
    • 3
  1. 1.Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg HospitalAarhus University HospitalAalborgDenmark
  2. 2.Mech-Sense, Department of Radiology, Aalborg HospitalAarhus University HospitalAalborgDenmark
  3. 3.Center for Sensory-Motor Interactions (SMI), Department of Health Science and TechnologyAalborg UniversityAalborgDenmark

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