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DOI: 10.1055/s-0028-1104754
© Georg Thieme Verlag Stuttgart · New York
Die opioidinduzierte Obstipation und ihre Behandlungsmöglichkeiten – Eine Analyse internationaler Fachartikel aus den Jahren 1997–2007
The opioid–induced constipation and options of treatment – An analysis of international medical and nursing literature from 1997 until 2007Publication History
Publication Date:
19 November 2008 (online)
![](https://www.thieme-connect.de/media/klinikarzt/200811/lookinside/thumbnails/10.1055-s-0028-1104754-1.jpg)
Die opioidinduzierte Obstipation gehört zu den häufigsten Nebenwirkungen bei der Behandlung von Menschen mit chronischen Schmerzen durch Opioide. Ihre Häufigkeit wird in der internationalen Fachliteratur mit 3–66 % angegeben. Die Auswirkungen auf die Darmfunktion können so schwerwiegend sein, dass die Dosierung der Opioide der Schmerzsituation nicht angepasst werden kann oder es zum Therapieabbruch kommt. Bei der Therapie der opioidinduzierten Obstipation haben sich Stimulanzien und osmotisch wirksame Laxanzien bewährt, auch wenn zahlreiche Nebenwirkungen den Behandlungserfolg oft limitieren. Füll– und Quellstoffe sowie Weichmacher werden dagegen nicht empfohlen. Opioidantagonisten sind eine vielversprechende Alternative: Ihre abführende Wirkung wurde in zahlreichen Studien belegt. Allerdings zeigten sich auch Analgesieverlust und Entzugssymptomatiken. Ein individuelles Behandlungskonzept und die Überprüfung des Behandlungsverlaufes durch Ärzte und Pflegende ist eine entscheidende Voraussetzung für eine erfolgreiche Behandlung.
The opioid–induced constipation is one of the most frequent adverse effects in treated patients with chronic pain with opioids. According to the international literature, the frequency of its occurrence is between 3 and 66 %. As a result, patients avoid increasing the dosage of opioids for pain relief and quit therapy in some cases. Stimulants and osmotic agents seem to be useful in the treatment of opioid–induced constipation. In contrast fiber bulking agents and stool softener can not be recommended. However, laxatives are associated with many adverse effects which limit the success of the treatment. Opioid–antagonists are a promising alternative for treatment. Studies show that they can replace laxatives and facilitate defecation. However, reversal of analgesia and withdrawal were observed in some patients. An individual assessment is needed as well as the control of the course of the treatment by physicians and nurses.
Key words
opioid–induced constipation - chronic pain - laxatives - opioid–antagonists - individual assessment
Literatur
- 1 Herndon CM, Jackson 2nd KC, Hallin PA.. Management of opioid–induced gastrointestinal effects in patients receiving palliative care. Pharmacotherapy. 2002; 22 240-250
- 2 Holzer P.. Opioids and opioid receptors in the enteric nervous system: from a problem in opioid analgesia to a possible new prokinetic therapy in humans. Neurosci Lett. 2004; 361 192-195
- 3 O'Mahony S, Coyle N, Payne R.. Current management of opioid–related side effects. Oncology (Williston Park). 2001; 15 80-82
- 4 Pappagallo M.. Incidence, prevalence, and management of opioid bowel dysfunction. Am J Surg. 2001; 182
- 5 Swegle JM, Logemann C.. Management of common opioid–induced adverse effects. Am Fam Physician. 2006; 74 1347-1354
- 6 Norton C.. Constipation in older patients: effects on quality of life. Br J Nurs. 2006; 15 188-192
- 7 Panchal SJ, Müller–Schwefe P, Wurzelmann JI.. Opioid–induced bowel dysfunction: prevalence, pathophysiology and burden. Int J Clin Pract. 2007; 61 1181-1187
- 8 Patanwala AE, Abarca J, Huckleberry Y, Erstad BL.. Pharmacologic management of constipation in the critically ill patient. Pharmacotherapy. 2006; 26 896-902
- 9 McMillan SC, Tittle M, Hagan S, Laughlin J.. Management of pain and pain–related symptoms in hospitalized veterans with cancer. Cancer Nurs. 2000; 23 327-336
- 10 Kyle G.. Constipation and palliative care – where are we now?. Int J Palliat Nurs. 2007; 13 6-16
- 11 Foss JF.. A review of the potential role of methylnaltrexone in opioid bowel dysfunction. Am J Surg. 2001; 182
- 12 Kurz A, Sessler DI.. Opioid–induced bowel dysfunction: pathophysiology and potential new therapies. Drugs. 2003; 63 649-671
- 13 Tamayo AC, Diaz–Zuluaga PA.. Management of opioid–induced bowel dysfunction in cancer patients. Support Care Cancer. 2004; 12 613-618
- 14 Klaschik E, Nauck F, Ostgathe C.. Constipation – modern laxative therapy. Support Care Cancer. 2003; 11 679-685
- 15 Thomas J.. Cancer–related constipation. Curr Oncol Rep. 2007; 9 278-284
- 16 Mercadante S, Villari P, Ferrera P, Casuccio A.. Opioid–induced or pain relief–reduced symptoms in advanced cancer patients?. Eur J Pain. 2006; 10 153-159
- 17 Thorpe DM.. Management of opioid–induced constipation. Curr Pain Headache Rep. 2001; 5 237-240
- 18 Locke GR, Pemberton JH, Phillips SF.. American Gastroenterological Association Medical Position Statement: guidelines on constipation. Gastroenterology. 2000; 119 1761-1766
- 19 Schwarzer A, Nauck F, Klaschik E.. Strong opioids and constipation. Schmerz. 2005; 19 214-219
- 20 Liu M, Wittbrodt E.. Low–dose oral naloxone reverses opioid–induced constipation and analgesia. J Pain Symptom Manage. 2002; 23 48-53
- 21 Bohn LM, Raehal KM.. Opioid receptor signaling: relevance for gastrointestinal therapy. Curr Opin Pharmacol. 2006; 6 559-563
- 22 Guest JF, Hart WM, Cookson RF.. Cost analysis of palliative care for terminally ill cancer patients in the UK after switching from weak to strong opioids. Palliative Care Advisory Committee. Pharmacoeconomics. 1998; 14 285-297
Korrespondenz
Prof. Dr. Jürgen Osterbrink
Institut für Pflegewissenschaft Paracelsus Medizinische Privatuniversität
Strubergasse 21
A-5020 Salzburg
Email: juergen.osterbrink@pmu.ac.at