Opioid-induced constipation

Abstract

A 50-year-old male with a history of severe lumbar stenosis presented to your clinic with pain intractable to NSAID therapy. After starting the patient on opioid therapy, he returns to your clinic with symptoms of straining, incomplete evacuation, and hard, dry stools. 1. What is the differential diagnosis? Opioid-induced constipation is the constellation of GI symptoms resulting from opioid use. Despite the effectiveness of opioids for pain management, opioid-induced constipation may significantly affect the quality of life for patients on opioid treatment.[1] In an opioid-naive patient presenting with constipation after starting opioids, opioid-induced constipation should be highly suspected. Other differential diagnosis of constipation may be divided into functional, structural, metabolic, neurologic, psychogenic, and drug causes (Table 67.1).[2] These causes must be considered in the evaluation of a patient presenting with constipation. Examples of functional causes of constipation include: diet, sedentary lifestyle, or motility disturbance. Examples of structural causes of constipation include: fissures, hemorrhoids, diverticulosis, or mass lesions resulting in obstruction. Examples of metabolic causes include: diabetes, hyperparathyroidism, hypercalcemia, hypokalemia, hypothyroidism, uremia, and pregnancy. Examples of neurogenic causes include: stroke, multiple sclerosis, spinal cord injury, and brain injury. Examples of psychogenic causes include: anxiety, depression, and somatization. Examples of drug causes include: opioids, anticholinergics, antidepressants, calcium channel blockers, psychotropics, diuretics, and levodopa.