Pain Meds Killing Your Bowel Movements? Opioid Induced Constipation.

How Acupuncture for Opioid Induced Constipation Can Help.

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What is Opioid Induced Constipation (OIC) ?

Opioid Induced Constipation (OIC) is a side effect that millions of people suffer with. At least 8 million of the 38 million people prescribed opioids for chronic non-cancer pain have reported this side effect according to the US Pain Foundation. That number could be low because bowel habits are not a subject anyone likes to talk about. The prescription of opioids has increased in numbers over the last decade despite concern and evidenced risk of side effects such as Opioid Induced Constipation, tolerance to the medication leading to increased dosages as well as opioid addiction. Because of the severity and discomfort of the constipation experienced, people will skip doses of their opioid medication which is not advised.

Opioids bind to mu-opiod receptors in the central nervous system and pain relief is experienced. However, these receptors are also found in the gastrointestinal tract. When opioids bind to the mu-opioid receptors in the GI tract, it inhibits the muscle contractions of the intestines called peristalsis which slows transit of waste material in the large intestine and colon.

How is OIC treated?

Chronic Pain is experienced by millions and is classified by unresolved pain lasting more than 3 months. Typically it is caused by tissue or nerve pain, often from acute injury or repetitive motion injury, though that is oversimplifying as chronic pain often has many layers with overlapping, combination factors. Opioids such as hydrocodone and oxycodone as well as combination drugs like percocet have become commonplace for treatment of chronic pain including things like headaches which typically can be addressed in other ways. Constipation arising from these medications many times goes unaddressed for many reasons. Some doctors are not aware of the side effect at all or the severity of the side effect. Some prescribing doctors may know that opioids can cause constipation and even mention it to the patient but they are often unaware when constipation is being experienced due to lack of reporting.

When a physician is aware that their patient is experiencing OIC, stool softeners and laxatives are suggested. There are two problems that arise with this. One, if the patient continues to have a problem it is possible they won’t bring it up again due to it already being an embarrassing subject; the doctor will remain in the dark. Two, laxatives become long-term and may cause a lazy bowel on top of the already inhibited GI tract.

Next up are relatively new medications that have come out to address OIC such as Relistor and Movantik. The commercials for these medications are quite controversial. Regardless of my personal feeling of the drugs themselves or the advertisements, the fact is that they have been successful in drumming up conversation about an otherwise unspoken topic.

These medications address the issue by blocking the opioid receptors in the gut. Combination therapies such as harsh laxatives may also be suggested to produce bowel movements. Besides the already known potential risk and side effects of the opioids themselves, the medications for OIC also have their own side effects such as gas, nausea, diarrhea, dizziness, increased sweating and more severe side effects such as abdominal pain and blood in the stool.

Acupuncture by itself has shown to decrease pain by up to 50% without the use of medications. When utilizing all parts of Traditional Chinese Medicine together, which includes herbs, food as medicine and nutritional counseling, lifestyle recommendations and acupuncture treatments, that percentage of pain reduction has the potential to be much higher. The benefits of TCM are not widely known about in the public and traditional medical world. We are working to change that so people have access to TCM and Acupuncture as a first line of defense before moving to a serious drug like opioids for pain relief. If already on opioids and experiencing OIC, acupuncture for constipation is a viable and safe solution.

Acupuncture for Constipation.

Constipation is caused by a few factors but it is the muscular contractions (peristalsis) that occur to move stool through the colon that opioids are inhibiting. Once stool is not being moved along, heat builds up drying the stool making it even more difficult to pass. In addition to the ability to reduce pain that opioids were prescribed for in the first place, Traditional Chinese Medicine, which includes acupuncture, can help relieve constipation. It also can help restore and retrain the GI tract and associated organ systems to function properly.

  • Chinese Herbs to produce a bowel movement quickly, naturally and safely.

  • Address deficiency in Spleen and Stomach systems caused by habitual and chronic constipation induced by pain killers.

  • Proper nutritional counseling to help restore healthy composition of stools.

  • Opioids affect cytokines which activate the immune inflammatory response and acupuncture has shown to modulate cytokines decreasing this response.

  • Traditional Chinese Medicine can help significantly reduce pain and may be an alternative to your opioid medication which is causing constipation. We can work closely with your prescribing physician if this is an appropriate option for you.

Our goal is not to have you avoid seeing your physician but rather embrace an opportunity to work together to help alleviate pain and associated side effects of opioids. This natural and integrative approach is a way to hopefully help avoid medications like this or at least start reducing dosages. Optimally we would like to start seeing chronic pain managed in a less medication aggressive manner as a first line of defense since TCM has shown to be effective for the relief of chronic pain conditions.