How can constipation and other common side effects of opioids be prevented or managed?
The best strategy is to prevent the constipation, but the measures that are generally useful in preventing constipation are not particularly helpful when it’s opioid-induced constipation. We generally encourage patients to take a laxative in combination with a softener. Most patients need to take these agents regularly, so it requires a lot of education. When it has been more than 2 days since their last bowel movement, we become more aggressive and prescribe tablets, liquids, suppositories, or enemas, depending on the patients’ preference and whether they have any contraindications. What about other common side effects? Cognitive blunting is probably the second most problematic side effect that patients describe. We help people to understand that during the first day or two of opioid therapy they are likely to be sedated, but that for many people sedation dissipates over time. For some, however, it persists, and we will use psychostimulants such as methylphenidate. Nausea also can occ
