Brenner Darren M, Stern Emily, Cash Brooks D
Northwestern University-Feinberg School of Medicine, 676 N. Saint Clair Ave Suite 1400, Chicago, IL, 60611, USA.
University of South Alabama, Mobile, AL, USA.
Curr Gastroenterol Rep. 2017 Mar;19(3):12. doi: 10.1007/s11894-017-0560-2.
Opioids are a mainstay in the treatment of chronic non-cancer pain syndromes, but their analgesic benefits come at a cost as opioid-related constipation occurs in 40-80% of individuals taking chronic opioids. Furthermore, as 10-20% of the population suffers from constipation at baseline, it should be expected that while a proportion of individuals will develop constipation as a direct consequence of opioids (OIC), others will experience it as an exacerbation of their baseline constipation (OEC). Herein, we review the evidence-based data for treatments directed at opioid-related constipation focusing on individuals with non-cancer pain syndromes and provide a template for the development of differentiated treatment algorithms for OIC and OEC.
Historical and current treatment protocols recommend traditional laxatives, but these are ineffective in up to 50%, due in part to the heterogeneous pathogenesis of constipation. Therapeutic decisions must be tailored to account for this overlapping pathogenesis. OIC and OEC are distinct entities. As such, additional research and guidelines should address these as different patient populations.
阿片类药物是治疗慢性非癌性疼痛综合征的主要药物，但其镇痛益处伴随着一定代价，因为40%-80%服用慢性阿片类药物的个体都会出现阿片类药物相关性便秘。此外，由于10%-20%的人群在基线时就患有便秘，因此可以预期，一部分个体将因阿片类药物直接导致便秘（阿片类药物诱导的便秘，OIC），而其他个体则会经历其基线便秘的加重（阿片类药物加重的便秘，OEC）。在此，我们回顾针对非癌性疼痛综合征患者的阿片类药物相关性便秘治疗的循证数据，并为制定OIC和OEC的差异化治疗方案提供模板。
历史和当前的治疗方案推荐使用传统泻药，但这些药物在高达50%的患者中无效，部分原因是便秘发病机制的异质性。治疗决策必须根据这种重叠的发病机制进行调整。OIC和OEC是不同的实体。因此，应将这些作为不同的患者群体进行更多研究并制定指南。
