Pharmacological treatment of constipation in palliative care
ABSTRACT PURPOSE OF REVIEW: The prevalence of constipation in palliative care patients varies. There is uncertainty about the choice from varying recommendations for pharmacological management of constipation and a varying clinical practice in palliative care settings. The purpose of the review was to evaluate the current recommendations of therapy guidelines and to determine the effectiveness and safety of laxative administration for the management of constipation in palliative care patients. RECENT FINDINGS: Despite the clinical importance, there are limited data on the efficacy and safety of laxatives in palliative care patients. The social acceptability varies from country to country, but overall, oral laxatives should, where possible, be used in preference. Systemic opioid antagonists, such as naloxone and methylnaltrexone have been studied in few clinical trials. There is a paucity of well designed, prospective, randomized controlled trials with large enough numbers of patients suffering from constipation and treated with pharmacological methods. SUMMARY: There are limited data available on the conventional pharmacological treatment of constipation in palliative care patients due to insufficient randomized controlled trials. However, subcutaneously administered methylnaltrexone was found to be effective in aiding of laxation and well tolerated with limited or transient side effects in palliative care patients.
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ABSTRACT: Spontaneous colonic motility in the urethane-anaesthetized ferret consists of two distinct types of contraction which correspond to the patterns recorded myoelectrically in conscious animals. This motility was abolished or greatly reduced when nervous conduction was prevented in the cervical vagi by cooling to below 4 degrees C. On rewarming the nerves the colonic motility returned, after a short latency, to the pre-cool level. Atropine transiently abolished colonic motility. On its return the motility was significantly reduced but still sensitive to vagal integrity. Thus the atropine-resistant colonic motility was also abolished or markedly reduced by cooling the cervical vagi to below 4 degrees C. On rewarming there was a longer latency for the return of motility compared to that before atropinization. Electrical vagal stimulation produced, after a short latency, large-amplitude colonic contractions. Following atropine, the short-latency response to electrical vagal stimulation was replaced in the majority of animals by a long-latency response whose characteristics were quite different from those of the cholinergic response. These results are consistent with the vagus containing two functional motor pathways to the colon, one to cholinergic post-ganglionic neurones and the other operating via a non-cholinergic mechanism.The Journal of Physiology 04/1984; 348:35-42. DOI:10.1113/jphysiol.1984.sp015097 · 4.54 Impact Factor
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ABSTRACT: Constipation is a frequent and distressing complication in patients with advanced cancer. However, very few studies have reviewed the assessment and management of these patients. The purpose of this study was to review the documentation and assessment and diagnosis of constipation in patients admitted to a Palliative Care Unit, and the correlation between those findings and radiological evidence of stool in the colon. The records of 122 consecutive patients admitted to the Palliative Care Unit, Edmonton General Hospital were reviewed in order to assess the physician's and the nurse's record of symptoms, physical findings, and diagnosis and treatment of constipation. All patients also underwent a flat abdominal radiograph that scored for the presence of stool in the colon (0 = no stool; and 12 = stool occupying all the lumen of the four quadrants of the colon). The radiograph was scored blindly by two different physicians. Of 103 evaluable patients, a rectal exam was reported only in 42. Correlation between the assessment by the two physicians' radiograph score was high (0.78, P nd nurses' diagnosis of constipation, the presence of laxative treatment, the number of days since the last bowel movement, and the source of the admission (hospital vs home) were not associated with higher radiological scores for constipation. Assessment is insufficient in this population at high risk for severe constipation. Radiological examination may be necessary for adequate diagnosis in some patients. More research is needed in this area.Journal of Pain and Symptom Management 12/1994; 9(8):515-9. DOI:10.1016/0885-3924(94)90113-9 · 2.74 Impact Factor
Palliative Medicine 04/1999; 13(2):159-60. · 2.85 Impact Factor