Panchal S J, Müller-Schwefe P, Wurzelmann J I
National Institute of Pain and Coalition for Pain Education Foundation, Tampa, FL 33558, USA.
Int J Clin Pract. 2007 Jul;61(7):1181-7. doi: 10.1111/j.1742-1241.2007.01415.x. Epub 2007 May 4.
As a result of the undesired action of opioids on the gastrointestinal (GI) tract, patients receiving opioid medication for chronic pain often experience opioid-induced bowel dysfunction (OBD), the most common and debilitating symptom of which is constipation. Based on clinical experience and a comprehensive MEDLINE literature review, this paper provides the primary care physician with an overview of the prevalence, pathophysiology and burden of OBD. Patients with OBD suffer from a wide range of symptoms including constipation, decreased gastric emptying, abdominal cramping, spasm, bloating, delayed GI transit and the formation of hard dry stools. OBD can have a serious negative impact on quality of life (QoL) and the daily activities that patients feel able to perform. To relieve constipation associated with OBD, patients often use laxatives chronically (associated with risks) or alter/abandon their opioid medication, potentially sacrificing analgesia. Physicians should have greater appreciation of the prevalence, symptoms and burden of OBD. In light of the serious negative impact OBD can have on QoL, physicians should encourage dialogue with patients to facilitate optimal symptomatic management of the condition. There is a pressing need for new therapies that act upon the underlying mechanisms of OBD.
由于阿片类药物对胃肠道产生不良作用，接受阿片类药物治疗慢性疼痛的患者常出现阿片类药物引起的肠道功能障碍（OBD），其中最常见且使人虚弱的症状是便秘。基于临床经验和全面的MEDLINE文献综述，本文为初级保健医生提供了OBD的患病率、病理生理学及负担的概述。OBD患者会出现多种症状，包括便秘、胃排空减慢、腹部绞痛、痉挛、腹胀、肠道传输延迟以及干结硬便的形成。OBD会对生活质量（QoL）以及患者自认为能够进行的日常活动产生严重负面影响。为缓解与OBD相关的便秘，患者常长期使用泻药（存在风险）或改变/停用阿片类药物，这可能会牺牲镇痛效果。医生应更深入了解OBD的患病率、症状及负担。鉴于OBD会对QoL产生严重负面影响，医生应鼓励与患者进行沟通，以促进对该病症的最佳症状管理。迫切需要针对OBD潜在机制的新疗法。
