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A examine led by College of Manchester epidemiologists has revealed which opioid painkillers are most probably to be related to constipation in sufferers with non-cancer ache.
Morphine, oxycodone, fentanyl and mixture opioids, they discovered, had been related to a considerably increased threat of extreme constipation when in comparison with codeine.
Tramadol, however, was related to the bottom threat of constipation when in comparison with codeine. The examine is printed in BMC Medication.
Sufferers on higher than 50 morphine milligram equal (MME) per day—a common measure of opioid energy—skilled the best threat of extreme constipation. Fifty MME per day is roughly equal to taking both 50mg of morphine or 33 mg of oxycodone every day.
Steerage from the UK College of Ache Medication of the Royal Faculty of Anesthetists’ Opioids Conscious website recommends the dose above which opioid harms seemingly outweigh advantages is 120 MME per day. Nevertheless, that is presently underneath evaluate.
The examine was carried out utilizing hospital digital well being data of 80,475 eligible sufferers in Northwest England between 2009 and 2020.
Opioid publicity was measured utilizing administered drug data from the hospital data, and a extreme constipation occasion was outlined because the administration of an enema or suppository.
The examine authors say that being conscious of the relative dangers permits well being care professionals to raised tailor ache administration methods to private wants. It additionally permits extra knowledgeable discussions with sufferers about their ache reduction dose and sort, together with selecting one with a decrease threat as applicable.
Senior creator Dr. Meghna Jani, NIHR Superior Fellow and Senior Medical Lecturer at The College of Manchester mentioned, “Constipation is a frequent opposed occasion related to opioid medicines that may have a substantial impression on sufferers’ high quality of life.
“As well as the major impact on activities of daily living, opioid-induced constipation has also been associated with longer hospital stays, higher hospital costs, and increased emergency department visits.”
Estimates of constipation charges inside digital well being data are more likely to underrepresent the true prevalence each in major and secondary well being care data, the researchers discover.
It’s because constipation could also be seen as much less critical and due to this fact not at all times coded, regardless of being talked about.
Sufferers might also wrestle to brazenly discuss their bowel habits with a well being care skilled, thereby not discussing it in the event that they get admitted to hospital, or not searching for well being recommendation after they do expertise it.
She added, “Beforehand, we did not know sufficient concerning the threat related to particular opioids, given the alternative ways they act on the physique, in addition to the impact of each day dose.
“This examine will enable scientific prescribers and sufferers to make higher shared choices about what ache reduction is greatest for them, to attenuate the dangers of this facet impact of opioids, and thus enhance sufferers’ high quality of life.
“If patients need to be on opioids, we urge prescribers to be cautious with opioid dosing, and aim for the lowest effective dose to manage pain while mitigating the risk of constipation and other side effects.”
Extra data:
Comparative threat of extreme constipation in sufferers handled with opioids for non-cancer ache: a retrospective cohort examine in Northwest England, BMC Medication (2025). DOI: 10.1186/s12916-025-04118-7
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College of Manchester
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Intestine response: Research reveals opioid ache relievers with highest constipation threat (2025, June 15)
retrieved 15 June 2025
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