Albany Medical College, Albany, NY.
Clin J Pain. 2020 Sep;36(9):716-722. doi: 10.1097/AJP.0000000000000852.
The objective of this study was to provide an overview of opioid-induced constipation (OIC) and its influence on disease burden and quality of life (QOL).
This is a narrative review.
For many patients, opioid-related side effects, the most common being OIC, have the potential to significantly impair patients' QOL. Patients with OIC often experience substantial overall burden (ie, increases in anxiety and depression, impairments in activities of daily living, low self-esteem, feelings of embarrassment) and economic burden (ie, higher health care costs, more frequent doctor visits, increased out-of-pocket medication costs), which often causes patients to modify or discontinue opioid treatment despite the analgesic benefits. OIC occurs when opioids bind to peripheral μ-opioid receptors in the gastrointestinal tract. Currently, 4 Food and Drug Administration (FDA)-approved medications are available for OIC, 3 of which are peripherally acting µ-opioid receptor antagonists (PAMORAs). PAMORAs block µ-opioid receptors in the gastrointestinal tract without affecting the central analgesic effects of the opioid and thus provide a targeted approach to OIC management. Two PAMORAs, naldemedine and methylnaltrexone, have shown significant improvements in QOL based on the Patient Assessment of Constipation Symptoms questionnaire relative to placebo. Along with pharmacologic management for OIC, health care providers should institute comprehensive communication strategies with patients to ensure OIC is effectively recognized and managed.
OIC has both physical and psychological impacts on patients. PAMORAs provide effective relief of OIC while also improving QOL. To augment the pharmacologic management of OIC, proactive counseling approaches between physicians and patients may help relieve some of the patient burden associated with OIC and lead to improved outcomes.
本研究旨在概述阿片类药物引起的便秘（OIC）及其对疾病负担和生活质量（QOL）的影响。
这是一篇叙述性综述。
对于许多患者来说，阿片类药物相关的副作用，最常见的是 OIC，有可能严重损害患者的 QOL。OIC 患者通常会承受巨大的整体负担（即焦虑和抑郁增加、日常生活活动受损、自尊心降低、尴尬感）和经济负担（即医疗保健费用增加、就诊次数增加、自付药物费用增加），这往往导致患者尽管有镇痛作用，但仍会修改或停止阿片类药物治疗。当阿片类药物与胃肠道中的外周 μ-阿片受体结合时，就会发生 OIC。目前，有 4 种经美国食品和药物管理局（FDA）批准的药物可用于 OIC，其中 3 种是外周作用的 μ-阿片受体拮抗剂（PAMORAs）。PAMORAs 阻断胃肠道中的 μ-阿片受体，而不影响阿片类药物的中枢镇痛作用，因此为 OIC 管理提供了一种有针对性的方法。两种 PAMORAs，naldemedine 和 methylnaltrexone，与安慰剂相比，基于患者便秘症状评估问卷，在 QOL 方面均显示出显著改善。除了 OIC 的药物治疗外，医疗保健提供者还应与患者实施全面的沟通策略，以确保有效识别和管理 OIC。
OIC 对患者既有身体上的影响，也有心理上的影响。PAMORAs 有效缓解 OIC 的同时也提高了 QOL。为了增强 OIC 的药物治疗效果，医生和患者之间积极的咨询方法可能有助于减轻与 OIC 相关的一些患者负担，并带来更好的治疗效果。
