Department of Gastroenterology, University College Hospital, London, UK.
Chronic Pain Policy Coalition (CPPC) Policy Connect, CAN Mezzanine, 32-36 Loman Street, London.
Pain Med. 2017 Oct 1;18(10):1932-1940. doi: 10.1093/pm/pnw240.
Laxatives are commonly used to treat opioid-induced constipation, the commonest and most bothersome complication of opioids. However, laxatives have a nonspecific action and do not target underlying mechanisms of opioid-induced constipation; their use is associated with abdominal symptoms that negatively impact quality of life.
To assess the effects of laxatives in patients taking opioids for chronic pain.
One hundred ninety-eight UK patients who had taken opioid analgesics for at least one month completed a cross-sectional online or telephone survey. Questions addressed their pain condition, medication, and laxative use (including efficacy and side effects). The survey also assessed bowel function using the Bowel Function Index.
Since starting their current opioid, 134 of 184 patients (73%) had used laxatives at some point and 122 (91%) of these were currently taking them. The most common laxatives were osmotics and stimulants. Laxative side effects were reported in 75%, most commonly gas, bloating/fullness, and a sudden urge to defecate. Side effects were more common in patients less than 40 years of age. Approximately half of patients said laxatives interfered with work and social activities, and one-fifth needed an overnight hospital stay because of their pain condition and/or constipation. Laxatives did not improve the symptoms of constipation, as assessed by the Bowel Function Index. Constipation was not related to opioid strength, dose of opioid, or number of laxatives taken.
Use of laxatives to treat opioid-induced constipation is often ineffective and associated with side effects. Instead of relieving the burden of opioid-induced constipation, laxative use is associated with a negative impact.
通便剂常用于治疗阿片类药物引起的便秘，这是阿片类药物最常见和最麻烦的并发症。然而，通便剂的作用是非特异性的，不能针对阿片类药物引起的便秘的潜在机制；它们的使用与腹部症状相关，这些症状会对生活质量产生负面影响。
评估通便剂在接受阿片类药物治疗慢性疼痛的患者中的作用。
198 名在过去一个月内服用过阿片类镇痛药的英国患者完成了一项横断面在线或电话调查。问题涉及他们的疼痛状况、药物和通便剂的使用情况（包括疗效和副作用）。该调查还使用肠功能指数评估了肠道功能。
自开始使用当前的阿片类药物以来，184 名患者中有 134 名（73%）在某些时候使用过通便剂，其中 122 名（91%）目前正在使用。最常用的通便剂是渗透性和刺激性的。通便剂的副作用报告发生率为 75%，最常见的是气体、腹胀/饱胀和突然有排便的冲动。副作用在年龄小于 40 岁的患者中更为常见。大约一半的患者表示通便剂干扰了工作和社交活动，五分之一的患者因为疼痛状况和/或便秘需要住院过夜。通便剂并没有改善便秘症状，如肠功能指数评估的那样。便秘与阿片类药物的强度、阿片类药物的剂量或使用的通便剂数量无关。
使用通便剂治疗阿片类药物引起的便秘通常无效，并伴有副作用。通便剂的使用不仅没有缓解阿片类药物引起的便秘的负担，反而与负面影响相关。
