What Is Opioid Induced Bowel Dysfunction?

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Opioid-induced bowel dysfunction (OBD or OIBD) is the collective term for the negative side effects on the digestive system from the use of opioid analgesic medications.

Opioid medications play an extremely important role in the management of moderate to severe pain. Medications in this class include morphine, oxycodone and hydromorphine, and are seen as the first line of treatment for conditions such as cancer pain, post-operative pain and chronic pain conditions, such as arthritis, back pain, headache, fibromyalgia, and peripheral neuropathy.

In the United States, prescriptions for opiate medication have been rising significantly over the past decade, leading to a rise in the number of cases of OBD.

Symptoms of OBD affect a signficantly large number of patients who take opioid medication. Unfortunately, for some, the severity of OBD symptoms leads to a premature discontinuation of their pain medication.

OBD differs from narcotic bowel syndrome (NBS), which is a condition in which a person experiences a paradoxical increase in abdominal pain when taking narcotic opioid medications.

Symptoms of OBD

Opioid medications appear to have a wide-range effect on the digestive tract. GI symptoms resulting from the use of such medications include:

    With the notable exception of constipation, many of these symptoms decrease as tolerance to the opioid medication develops.

    Effect of Opioids on the Digestive Tract

    Opioids are used for pain reduction because of their effect on the neurons of the nervous system. The enteric nervous system (ENS) is the part of the nervous system that controls the workings of digestion.

    Therefore, the digestive tract contains an extremely high number of neurons. Opioids thus affect the working of these neurons, resulting in unpleasant digestive system side effects.

    Through their effect on the enteric nervous system, opioids affect digestive system motility and fluid absorption and secretion. Thus they can affect the digestive system from start to bottom. They can affect the contractions of the esophagus as well as the workings of the lower esophageal sphincter, resulting in difficulty swallowing and acid reflux. Stomach emptying may be slowed, with a decrease in pancreatic enzymes and bile, all interfering with the normal process of digestion.

    At the lower end of the digestive tract, movement of material through the small and large intestines is slowed. Opioids also affect the amount of liquid in stool: they increase the amount of fluid being taken out of the stool and decrease the amount of fluid that might otherwise flow back into the stool. The prolonged time of fecal material within the large intestine, coupled with decreased fluid levels, results in hard stool and constipation.

    At the very end of the digestive tract, opioids can affect the functioning of the anal sphincter, which can also contribute to constipation due to changes in the way that the body senses the presence of stool.

    Treatment of OBD

    Conventional treatment of OBD includes the use of laxatives and prokinetic medications for gastroparesis and constipation. Changes to opioid use may be recommended - either a decrease in the amount used or a change from oral medications to those administered in a transdermal manner (through the skin). Typically, these conventional treatments options offer little in the way of symptom relief.

    New medications are becoming available which target receptor cells of the neurons found within the digestive tract. These medications appear to reduce unwanted digestive side effects, without impairing the pain-relieving properties of the opioid medication. Medications in this class include:

    • Movantik (naloxegol)
    • Relistor (methylnaltrexone)
    • Targin (combination of oxycodone and naloxone/Narcan


    Holzer, P. "New approaches to the treatment of opioid-induced constipation" European Review for Medical and Pharmacological Sciences 2008 12:119-127.

    Leppert, W. "Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction" Drug Design, Development and Therapy 2015 9:2215-2231.

    Nelson, A. & Camilleri, M. "Chronic opioid induced constipation in patients with nonmalignant pain: challenges and opportunities" Therapeutic Advances in Gastroenterology 2015 *:206-220.

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