Monday, May 04, 2009
This multinational, Internet-based survey was designed to assess the prevalence, frequency, severity, and impact of opioid-induced bowel dysfunction in patients receiving opioid therapy for chronicpain and taking laxatives.
At the time of the survey, 45% of 322 patients reported <3 bowel movements per week. The most prevalent opioid-induced side effects were constipation (81%) and straining to pass a bowel movement (58%). Those side effects considered most bothersome by patients were (in order of rank) constipation, straining, fatigue, small or hard bowel movements, and insomnia.
Most of the OBD symptoms specified in the questionnaire were experienced by the majority of patients >or=4 times a week. Constipation was most often reported as severe. Most patients reported that their opioid-induced bowel dysfunction symptoms had at least a moderate negative impact on their overall quality of life and activities of daily living. A third of patients had missed, decreased or stopped using opioids in order to make it easier to have a bowel movement.
These gastrointestinal symptoms add to the burden already experienced by chronicpain patients, negatively impacting quality of life and, in some cases, affecting opioid treatment itself. (Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, Milanova T, Williamson R: The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain Medicine. 10(1):35-42, 2009 Jan.
This following randomised, double-blinded study evaluated the analgesic efficacy of prolonged-release (PR) oral oxycodone when co-administered with PR oral naloxone, and its impact on opioid-induced constipation in patients with severe chronicpain. Another objective was to identify the optimal dose ratio of oxycodone and naloxone.
A total of 202 patients with chronicpain (mainly non-cancer related, 2.5% of patients had cancer-related pain ) under stable oral oxycodone therapy (40, 60 or 80 mg/day) were randomised to receive 10, 20, 40 mg/day naloxone or placebo. After a 4-week maintenance phase, patients received oxycodone only for 2 weeks. Pain intensity was evaluated using a numerical analogue scale and bowel function was assessed using the bowel function index.
No loss of analgesic efficacy with naloxone was observed. Mean pain intensity scores on randomisation were comparable for placebo, 10mg, 20mg and 40 mg naloxone dose, and remained unchanged during treatment. Bowel function improved with increasing naloxone dose. Naloxone 20mg and 40 mg significantly improved bowel function at the end of the maintenance phase compared with placebo (p<0.05). Overall, the combination was well tolerated, with no unexpected adverse events. There was a trend towards an increased incidence of diarrhea with higher doses of naloxone. The 2:1 oxycodone/naloxone ratio was identified as the most suitable for further development.
It was concluded that the co-administration of PR oral naloxone and PR oral oxycodone is associated with a significant improvement in bowel function compared with PR oral oxycodone alone, with no reduction in the analgesic efficacy of oxycodone. (Meissner, Winfried. Leyendecker, Petra. Mueller-Lissner, Stefan. Nadstawek, Joachim. Hopp, Michael.Ruckes, Christian. Wirz, Stefan. Fleischer, Wolfgang. Reimer, Karen: A randomised controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. European Journal of Pain: Ejp. 13(1):56-64, 2009).
www.stopmusclepain.com
chronic pain,
constipation,
opioides
Monday, May 04, 2009
This multinational, Internet-based survey was designed to assess the prevalence, frequency, severity, and impact of opioid-induced bowel dysfunction in patients receiving opioid therapy for chronicpain and taking laxatives.
At the time of the survey, 45% of 322 patients reported <3 bowel movements per week. The most prevalent opioid-induced side effects were constipation (81%) and straining to pass a bowel movement (58%). Those side effects considered most bothersome by patients were (in order of rank) constipation, straining, fatigue, small or hard bowel movements, and insomnia.
Most of the OBD symptoms specified in the questionnaire were experienced by the majority of patients >or=4 times a week. Constipation was most often reported as severe. Most patients reported that their opioid-induced bowel dysfunction symptoms had at least a moderate negative impact on their overall quality of life and activities of daily living. A third of patients had missed, decreased or stopped using opioids in order to make it easier to have a bowel movement.
These gastrointestinal symptoms add to the burden already experienced by chronicpain patients, negatively impacting quality of life and, in some cases, affecting opioid treatment itself. (Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, Milanova T, Williamson R: The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain Medicine. 10(1):35-42, 2009 Jan.
This following randomised, double-blinded study evaluated the analgesic efficacy of prolonged-release (PR) oral oxycodone when co-administered with PR oral naloxone, and its impact on opioid-induced constipation in patients with severe chronicpain. Another objective was to identify the optimal dose ratio of oxycodone and naloxone.
A total of 202 patients with chronicpain (mainly non-cancer related, 2.5% of patients had cancer-related pain ) under stable oral oxycodone therapy (40, 60 or 80 mg/day) were randomised to receive 10, 20, 40 mg/day naloxone or placebo. After a 4-week maintenance phase, patients received oxycodone only for 2 weeks. Pain intensity was evaluated using a numerical analogue scale and bowel function was assessed using the bowel function index.
No loss of analgesic efficacy with naloxone was observed. Mean pain intensity scores on randomisation were comparable for placebo, 10mg, 20mg and 40 mg naloxone dose, and remained unchanged during treatment. Bowel function improved with increasing naloxone dose. Naloxone 20mg and 40 mg significantly improved bowel function at the end of the maintenance phase compared with placebo (p<0.05). Overall, the combination was well tolerated, with no unexpected adverse events. There was a trend towards an increased incidence of diarrhea with higher doses of naloxone. The 2:1 oxycodone/naloxone ratio was identified as the most suitable for further development.
It was concluded that the co-administration of PR oral naloxone and PR oral oxycodone is associated with a significant improvement in bowel function compared with PR oral oxycodone alone, with no reduction in the analgesic efficacy of oxycodone. (Meissner, Winfried. Leyendecker, Petra. Mueller-Lissner, Stefan. Nadstawek, Joachim. Hopp, Michael.Ruckes, Christian. Wirz, Stefan. Fleischer, Wolfgang. Reimer, Karen: A randomised controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. European Journal of Pain: Ejp. 13(1):56-64, 2009).
www.stopmusclepain.com
chronic pain, constipation, opioides