Opioids have gotten a bad name over the past several years because so many people have overdosed and died. But opioids have been used for millennia. The ancient Assyrians, Sumerians and Egyptians recognized the power of the opium poppy to ease pain. Modern medicine uses synthetic analogs and derivatives of natural opioids for people whose cancer pain would be unbearable otherwise.
Cancer is not the only painful condition for which opioids help make each day livable. We have heard from many readers like this one: “I have been a chronic care disabled patient after a five-car accident that left me severely injured. After 15 years of procedures, I was told I would be on pain meds the rest of my life by a neurosurgeon who is the best in my state!
“I attempted several times to detox with professional help and went through withdrawal only to get put back on my pain meds because I had a child to raise alone and could not get out of bed to care for her due to my pain.”
One of the most common complications of opioid pain relievers is constipation. This kind of bowel problem is not easily managed with fiber or fluids. One reader shared his experience:
“I’m two weeks out of the hospital from knee replacement. The pain of the opioid-caused constipation was worse than the knee, and I refused to leave the hospital until I was helped to gain control. The protocol to prevent binding was not adequate at all, so I was caught off guard. (There was no fiber in the hospital diet except sugary cereals.)”
Health professionals often recommend fiber, increased fluids, exercise and laxatives to treat opioid-induced constipation. There are, however, some new prescription medications that may be helpful for this common complaint.
The Food and Drug Administration approved naloxegol (Movantik) in 2014 to overcome OIC due to drugs such as hydrocodone or oxycodone. Since then, drug companies have developed other medications for this problem.
They include methylnaltrexone (Relistor) and naldemedine (Symproic). All of these medications work by counteracting opioid activity within the digestive tract. While these drugs can help, they are far from perfect. They perform best in combination with the nondrug approaches described above.
Side effects can include abdominal pain. If it gets bad, people should discontinue the drug and get medical attention promptly. GI perforation is a rare but very serious complication. Other adverse reactions include nausea, diarrhea and rash.
Here is one reader’s report: “I’ve been taking Movantik for about a month now and I love it. It is the only thing that has helped my OIC. Other laxatives do not work and MiraLAX makes me nauseated.
“I started off by taking it as needed at bedtime and have always been relieved first thing in the morning. I’m starting to take it daily now to see how it goes.”
Opioids remain valuable tools against intolerable pain. Cancer patients and people who require chronic pain medicines need all the help they can get. Having antidotes to opioid-induced constipation is an important addition to traditional recommendations.
Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website:
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