背景:阿片类药物对急性和慢性疼痛有效,但是它们的使用通常与难以控制的便秘和其他胃肠道(GI)效应有关,因为它们对肠道中的外周μ阿片受体有影响。阿片类药物引起的便秘(OIC)的机制与功能性便秘(FC)的机制不同,OIC可能对大多数FC的一线治疗反应不佳。OIC对生活质量(QoL)的影响会导致一些患者减少或停止阿片类药物治疗以缓解或避免便秘。
目标:在伊斯兰会议组织圆桌会议上,一个工作组为跨学科的OIC诊断制定了共识定义,并回顾了目前的OIC治疗方法和开发中的治疗潜力.通过协商一致,OIC定义如下:“从基线排便习惯开始阿片类药物治疗时的变化,其特征在于以下任何一项:排便频率降低,排便紧张的发展或恶化,一种不完全的直肠排空的感觉,或更硬的粪便稠度。工作组注意到先前对患者反应结果和临床试验终点的验证,并建议未来努力创建针对OIC的治疗指南和QoL措施。本文介绍了工作组讨论的细节以及对患者护理和研究的共识建议。
BACKGROUND: Opioids are effective for acute and chronic pain conditions, but their use is associated with often difficult-to-manage constipation and other gastrointestinal (GI) effects due to effects on peripheral μ-opioid receptors in the gut. The mechanism of opioid-induced constipation (OIC) differs from that of functional constipation (FC), and OIC may not respond as well to most first-line treatments for FC. The impact of OIC on quality of life (QoL) induces some patients to decrease or stop their opioid therapy to relieve or avoid constipation.
OBJECTIVE: At a roundtable meeting on OIC, a working group developed a
consensus definition for OIC diagnosis across disciplines and reviewed current OIC treatments and the potential of treatments in development. By
consensus, OIC is defined as follows: \'A change when initiating opioid therapy from baseline bowel habits that is characterized by any of the following: reduced bowel movement frequency, development or worsening of straining to pass bowel movements, a sense of incomplete rectal evacuation, or harder stool consistency\'. The working group noted the prior validation of a patient response outcome and end point for clinical trials and recommended future efforts to create treatment
guidelines and QoL measures specific for OIC. Details from the working group\'s discussion and
consensus recommendations for patient care and research are presented in this article.