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While opioids (narcotics) can be helpful with chronic pain, they can also have significant side effects. Constipation is one of the main negative effects.
And we’re not talking a minor “slow down.” Indeed, opioid-induced constipation can persist despite strong medication to relieve it. In rare cases, it can progress to obstruction – “nothing going through.”
The first FDA-approved medication to counteract this side effect is Relistor (methylnaltrexone bromide). It’s an injectable medication, approved for patients with later-stage advanced illness who use a continual regimen of opioids. Because it doesn’t cross into the brain, it shouldn’t decrease pain relief.
A clinical trial is reported in JAMA 2000, Vol 283, pg 367-372.
An interesting side-story of this medication is that it was originally developed by pharmacologist Leon Goldberg, MD, PhD, to help a friend with a terminal illness who was on morphine and had severe constipation. A true humanitarian.
Grand Rounds, a medical blog carnival, is up at MDOD. Funny guys over there… I think they might be the judges for the Darwin awards.
8 responses so far ↓
Anthony // Oct 8, 2008 at 10:19 am
I’m on a continual regimen of opioids myself, and I find this somewhat ridiculous. There are so many different natural ways to cure constipation.
I drink aloe juice daily (yes, aloe is edible), and it works wonders.
How to Cope with Pain // Oct 8, 2008 at 1:35 pm
Anthony, it sounds like for you it’s hard to believe that opioids, for some people, can cause a life-threatening blockage. Your own experience has been different, thankfully.
For certain pts, this medication might enable them to tolerate a dose of opioids that had previously helped their pain, but which had too severe side effects.
Thanks for sharing what helps you.
Maureen // Oct 8, 2008 at 7:26 pm
Thank you for this important information. Despite Anthony’s experience, I haven’t found any natural ways to help cure the constipation I suffer from the opioids I take for pain relief, and have had suffered one blockage because of this. It is an on-going battle, trying to balance my pain control with the constipation, and there haven’t been many treatments options that worked. I hope this new medication proves to be a help to those of us who need it, and I thank you for making me aware of it’s approval.
Maureen
Http://Beingchronicallyillisapill.blogspot.com
Lisa // Oct 14, 2008 at 4:17 am
I much prefer natural *everything*, but since opiods have become rather necessary, I’ve discovered that even my vegetarian, whole grain, much fibre diet hasn’t been enough.
Further, even adding fibre supplements and using other natural helpers still hasn’t done the trick. The resulting very severe constipation can, as Maureen notes, cause intestinal blockage. I’ve had this happen; it was VERY unpleasant. If this new medication can balance this benign-sounding but potentially dangerous side effect, it will certainly relieve much suffering.
Do you know of Relistor being approved for use in Canada?
How to Cope with Pain // Oct 14, 2008 at 8:38 pm
Lisa, I’m not sure about approval in Canada. You could search Relistor online and see if it’s approved there.
And except for end-stage cancer, it’s not FDA approved here in the US, but I bet will start to be used for many indications, though “off-label.”
TJ // Nov 8, 2009 at 4:05 pm
i am a 53 year old lady with constipation when i fart it hurts i eat and drink all the right stuff and i just sit on the loo grunting pushing and straining i have been 2 my dr he can not do anything i have been constipted for nilly 3 weeks please help me its almost my birthday i dont want 2 b constipated on my 54 thxz
How to Cope with Pain // Nov 9, 2009 at 9:49 am
TJ, as you know, I can’t recommend specific treatment, but I can recommend that you consider going to a GI doctor, or ask you pain medicine doctor to recommend someone whom you can see to address this problem. It can have serious consequences, so it’s important to treat the problem. Good luck!
Margie // Nov 17, 2009 at 6:57 am
Hi everyone, I too have serious constipation and have tried all the meds and all the natural suggestions (including aloe juice and also prune juice) and while prune juice worked occasionally – I have crps and nothing in my body works in a rational way. I have continuous fissure with intensive bleeding, i also got peroneal hematomas when I took movical as it gets my muscles working without the desired outcome. Trust the young male docs to be at the emergency dept when its such an unsavoury condition haha lucky i was in too much pain to care!
It is interesting how people are derisive of things that they have no idea about, (they only think they know) cos, if they did know, they would talk with knowledge instead of limited educated opinions. but still, I wouldn’t wish my physiological problems on Anthony or anyone else. Shame on them though….
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