Dear Friends,

Let me begin by apologising for any typo's or spelling errors, the preview option no longer appears to be with us?

I am writing with regard to constipation and it's effective management. I must be candid and say that this question was initialy inspired not so much by the experience of myself and other opioid dependent peers but by the struggle my Mother has had finding effective pain relief for Shingles ( the pain is severe in her case)without the debilitating and distressing side effect of constipation.

Yes, this may be a 'holy grail' for many of us but my own experience has been that co-danthrusite has proven very effective, yet gentle, and that adverse effects on bowel movement have been minimal compared with more frequantly used laxatives, etc.

In this case the most effective pain relief (for my mother) has proven to be opioid analgesics ( Trammadol) but the constipation associated with it (this is a non opioid tolerant individual) has led to discontinuation of medication and a corresponding increase in the severity of pain.

Any suggestions as to a compromise pain relief regime that would allow use of Trammadol but relieve the constipation?

Although this problem is common to all opioid users / patients it is still a little discussed issue that impacts on dependent and non dependent patients alike.Irespective of prescribed/non prescribed sourcing and the grounbds for use.

I am aware that a number of Doctors feel that diet, liquid intake, etc, are and can prove safe and effective measures to alleviate this side effect and feel that use/over use of
'laxatives', stool softners ,etc, can cause long term harm to the bowel function and are therefore reluctent to employ 'laxatives'
as a routine management measure.

I accept and sympathise with this to a considerable degree but in those cases where the above measures fail to afford relief what are the best medications used?

What are most likely to adversley impact on bowel movement, tone and function, especially given the high incidence of irritable bowel like symptoms in long term opioid dependent patients ( a subject that I feel has been neglected ...could it be that IBS is related to
endogenous endorphin dysfunction..indeed possibly be an indicator of it?).

While the inspiration for this question comes from a non dependance related inspiration the issue impacts on all opioid using individuals irrespective of the reasons for use and dependent/non dependent condition.

To return to the IBS theme I have been struck by the number of clients and peers who relate IBS like symptoms that anecdotal reports suggest MMT only partially alleviates. It also seems to be associated with the high incidence of stress and anxiety related conditions in this patient cohort. It also is curious that
this seems to be less problematic among patients recieving Opium derived agonists as opposed to synthetics and semi synthetics.

Obviously it may prove that chronic or long term administration of opioids could produce
bowel disorders as a consequance of constipation, and agonist effects on bowel function/control & movement anyway, but many of the anecdotal reports I encounter seem to indicate this to have been a problem prior to aqquisition of dependence.

I also note that endogenous endorphin receptors have been identified in the gut and bowel so it may not be barking mad to speculate that there could be a possible link in some individuals between IBS symptoms and endorphin 'dysfunction'.

Or am I barking up the wrong tree here?

Curious, Alan J.

Alan,
I do know that co-danthramer preparations are supposedly only to be prescribed in the terminally ill.
I always try to ask patients if they have bowel problems as it can be a bit embarassing for patients to ask.
We find the movicol sachets given in enough quantity can be helpful with dietary changes where needed. Lots of fruit and veg and fruit juice and plenty of fluids. A colleague recentlly told me that kiwi fruit is very helpful.
We have had some patients with severe problems requiring enemas and hospital admission.