Abdominal cancer pain relief


However, these medications have multiple side effects, opioid-induced constipation OIC being one of the most common adverse effects encountered in clinical practice. Several tools can be used to diagnose OIC, but asking patients about changes in bowel habits since starting opioids is essential, otherwise OIC may go undiagnosed.

Keywords opioid-induced constipation, Rome IV criteria, laxatives, peripherally acting mu-opioid receptor antagonists, chloride channel activators, guanylate cyclase-C receptor agonists Rezumat Opioidele, prescrise de medicii oncologi şi de cei de în­gri­ji­re paliativă pentru uşurarea durerii din cancer, au efecte se­cun­dare multiple, constipaţia fiind unul dintre cele mai frec­vente.

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Constipaţia produsă de opioide poate să ră­mâ­nă ne­diagnosticată dacă pacientul nu este întrebat despre orice schim­bare apărută în funcţionalitatea trac­tu­lui digestiv după în­ce­perea terapiei cu opioide. Pre­ve­nirea constipaţiei este esen­ţială pentru bunăstarea pacientului şi pentru succesul tra­ta­mentului cu opioide.

Constipaţia poate fi tratată cu diferite me­di­camente, cum sunt laxativele, antagoniştii periferici ai receptorului opioid mu, activatorii canalelor de clor sau ago­niştii receptorilor guanilat-ciclazei-C, descrise în acest articol.

Cuvinte cheie constipaţie indusă de opioide criteriile Roma IV laxative antagonişti periferici ai receptorului abdominal cancer pain relief mu activatori ai canalelor de clor agonişti ai receptorilor guanilat-ciclazei-C Opioids are essential drugs in relieving suffering from pain in the cancer population.

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Unfortunately, these drugs have significant side effects, including constipation, nausea and vomiting, pruritus, respiratory depression, opioid-induced neurotoxicity and opioid-induced hypogonadism, as well as the possibility of accidental overdose and death.

Constipation is defined by the Rome IV criteria abdominal cancer pain relief two or more of abdominal cancer pain relief following symptoms present for at least three months prior to the diagnosis: 1. Fewer than three spontaneous bowel movements per week. Loose stools are rarely present without the use of laxatives.

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Insufficient criteria to diagnose irritable bowel syndrome with predominant constipation or mixed bowel habits 2. OIC can occur days to weeks after the initiation of opioids, may get worse after changing or increasing the opioid dose, and persists even after the patient develops opioid tolerance. OIC may be less intense with transdermal fentanyl or methadone 2,3.

Several studies have shown that OIC may be more common human papillomavirus vaccine lactation more severe in the following circumstances: 1.

Female gender. Higher level of education.

Constipaţia indusă de opioide

Moderate to severe psychosocial impairment i. Unemployed or disabled because of health-related problems 4. Cancer diagnosis treated with taxanes, Vinca alkaloids, thalidomide or bortezomib.

Lack of privacy, such as the inpatient setting. Sedentary lifestyle.

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Decreased fluid or fiber intake. The pathology of OIC appears to be secondary to delayed gastrointestinal peristalsis and increased sphincter tone caused by opioid stimulation of the mu and delta receptors found in the enteric nervous system ENS. This triggers decreased gastrointestinal GI transit, with increased water resorption that in turn leads to hard stools and constipation 5. The prevalence of OIC is high, though literature is not consistent regarding its frequency.

The most common symptoms encountered by patients developing OIC are: bloating, heartburn, nausea, sometimes vomiting, decreased appetite, abdominal cancer pain relief pain, and passing of hard stool with straining 5. Several scales may be used to diagnose OIC, such as: 1.

Bristol Stool Form Scale, which classifies the forms of feces into 7 groups, with types 1 and 2 described above representing constipation, types 3 and 4 being the normal, and types 5 to 7 representing diarrhea 5. Each item is scored on a scale between 0 andwith scores less than 28 representing a normal bowel function 5.

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A score of 0 is considered normal 5,8. Patient Assessment of Constipation Symptoms PAC-SYM is a item questionnaire assessing the severity of constipation on a 5-point scale from 0 to 4 in three domains: stools, abdominal symptoms and rectal symptoms, abdominal cancer pain relief the past two weeks. A score of 0 rules out the presence of constipation 8. Constipation Assessment Scale CAS is a patient-administered questionnaire assessing the severity of multiple symptoms, such as: abdominal distension, flatus, frequency of bowel movements, consistency and volume of stools, presence of pain with defecation, and presence of rectal fullness or pressure.

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A score of 0 represents the normal, whereas a score abdominal cancer pain relief 16 is suggestive of severe constipation 9. The diagnosis of OIC is made clinically, by interviewing the patient, and by physical examination, including a rectal exam if the white blood count WBC and platelet count permit. Imaging studies, such as plain abdominal X-ray, can also help in the diagnosis of OIC, or be used to rule out the evidence of obstruction. A useful tool is the constipation score obtained by assessing abdominal cancer pain relief content of stool on a plain abdominal X-ray divided into four quadrants, using a scale from 0 to 3, where 0 represents the absence of stool and 3 represents stool impaction.

The maximum score is 12, and a score of 7 or above is suggestive for severe constipation, requiring aggressive management The treatment of OIC involves both non-pharma­co­lo­gical and pharmacological approaches.

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The non-pharmacological approach includes counseling patients to increase their fiber and fluid intake. Eating fruits like apples, prunes and bananas, or vegetables like string beans, spinach and peas, as well as avoiding constipating foods like dairy products can be helpful. However, it is recommended not to exceed grams of fiber daily to avoid feeling bloated.

Although physical exercise can raise serious challenges in patients with advanced cancer, it should also be encouraged whenever possible.

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Sometimes a simple clockwise abdominal massage can bring some relief from OIC 5, The pharmacological approach involves the use of laxatives, peripherally acting mu-receptors antagonists PAMORAs agents, chloride channel activators, guanylate cyclase-C receptor agonists, suppositories and enemas. Guidelines provided by the European Society for Medical Oncology recommend that laxatives, presented in Table 1, should be routinely prescribed to prevent and treat OIC.

Table 1. Common laxatives 2,3,5,6,8,11 The European Consensus Group on Constipation recommends using a combination of osmotic and stimulant laxatives 8.

PAMORAs, listed in Table 2, act by blocking opioids from binding to the peripheral mu-opioid receptors located in the gut.

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It is generally accepted that they do not cross the blood-brain barrier to interfere with the analgesic effect abdominal cancer pain relief the opioids 3,6. However, caution is advised in patients who may have a disruption of the blood-brain barrier, such as primary or secondary cancers of the central nervous system CNS abdominal cancer pain relief after brain iradiation 7.

Table 2. Peripherally acting mu-opioid receptors antagonists PAMORAs 2,3,5,6,7,8,11,12 Chloride channel activators act by stimulating the chloride channels in the gut, thus increasing fluid secretion and fecal transit. Lubiprostone at a dose of 8 or 24 mcg twice a day does not interact with the cytochrome CYP3A4, which makes it an attractive option for patients on polypharmacy.

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This medication is contraindicated for abdominal cancer pain relief with known or suspected bowel obstruction 3,5, Guanylate cyclase-C receptor agonists, such as linaclotide at doses of 72, or mcg a day, plecanatide at 3 mg daily, and prucalopride, are approved for chronic idiopathic constipation and irritable bowel syndrome with constipation predominance.

In conclusion, clinicians prescribing opioids for pain relief need to remember that OIC is one of the most frequent side effects and cannot be overlooked. Prevention is the best way to manage OIC, even though currently we have a plethora of drugs to treat it.

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