Opiate induced constipation mgmt
 

Hi folks,

New here but have done a little digging around. I know there are a lot of threads on here relating to the subject, but I was hoping to get a consensus from other folks in the same boat as myself as to a recommended daily/weekly regimen that shows success.

I am, as many of you are too I suspect, victims of back pain. I have had a total of 4 surgeries on my spine, the first a cervical fusion in '04, followed by laminotomy and laminectomy at the L5-S1 joint. While the cervical fusion was a moderate success, reducing pain by ~40%, the lumbar surgeries were total failures. As a result, I had L4-S1 fused in '09. As with most fusions, this too was a total failure.

Since that time, I have been on every opiate out there, from morphine to fentanyl to opana. My tolerance was increasing so quickly that I was concerned as to what would happen later in my life (I'm only 38), so I explored my options. Neurostimulator trial was a miserable week, so I ended up with an intrathecal pain pump installed in July 2010. I now receive just over 1mg/day thru the pump and take 10mg Percocet for breathru.

Throughout the course of all this, I have has some battles w/ constipation, mostly minor, but one moderate to severe impaction from the Fentanyl patch back in '07, that I had to digitally remove.

Just recently, things have began getting very bad again and the constipation has spun out of control. I now watch everything I put in my mouth and am downright scared of taking a percocet for fear of what it will do to me.

I have used prune juice, suppositories, enemas (saline & mineral oil), dulcolax pills), Milk of Mag, Miralax, and of course, mag citrate when absolutely necessary. I eat as much insoluble fiber as possible, and try to get in a large salad every couple days, but I am still constipated, to varying degrees, almost all the time.

I went in today for a pump refill and talked to my doc...he recommended the usual (fiber, veggies, MOM, a brown cow--milk of mag mixed w/ prune juice and all the other usual things), but stopped short at any kind of daily or weekly plan other than "If you're on day 3 with no action, drink 1/2 bottle of mag citrate." I know mag citrate works, but I don't have the time to spend 6 hours, twice a week, camped out next to the bathroom.

Does anyone have any sort of regular routine that they use to remedy this? Is there something I'm missing here?

I know occasionally I get where I haven't "gone" in 2-3 days, and that's when I use a Dulcolax (sp) suppository. It's gentle, works fast, and I get relief quickly. I don't have to use them often, thankfully but when I do I sure get results!

Perhaps they'd work well for you too. I know we should be able to go naturally, but darn it there are just times when that doesn't work! :mad: These darn meds screw things up! It doesn't seem to matter WHAT I eat -- my body just "clams up." LOL

I wish you the best. Take care and God bless. Hugs, Lee :)

I had lumbar fusion and laminectomy over seven years ago. Also developed PN. Pain is 24/7.

Constipation has been a real problem for the past several years. I have to take Mirlax daily or will get constipated almost immediately. I take 60 mgs's Oxycontin every 6 hrs. for a total of 240 mg's of Oxycontin in a 24 hr. period. Also take a few Percocet breakthru each day as well. If things get a bit to runny, occasionally, I will take some Metamucil which helps things to form a little better. This is an unfortunate side effect to the pain meds.


Gerry

Different Kind of Constipation
 

My doctor told me that when suffering from constipation caused by opiod use, I should not take fiber. This constipation is caused by the intenstinal tract slowing down, because of the drug use. The fiber will just cause more back up. I was prescribed Lactulose and it is wonderful. It often works in 6 hrs to overnight. I would be miserable without it.

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constipation
 

Fibre has been found to have a lot of detrimental effects, and can be hard on the digestive system, so caution is advised.
One of those things that sounds logical but in practice doesn't work as expected.
What works for me is magnesium chloride. This is really just concentrated seawater but high in magnesium. I take 5-10ml a day in lots of water.
I now take enough to keep me regular bot not too loose either.
The beauty of magnesium is that it has a lot of health benefits, is a vital mineral, and most are deficient in it.
Lots of info on the web.
Once you catch up to the body's needed level, you start to get loose bowels, so that's the time to reduce the dose a little.
The tablets you can get aren't nearly as good, but the powder is OK.

I agree with taking too much fiber. My GI doctor said as long as I was on Narcotics daily, I would need Miralax. I had issues with occasionally getting to loose. She said to take Psyllium Husk (Metamcuil contains this) when this happens. Of course, the fiber is not to be taken daily.


Gerry

Working in oncology and then hospice, most of the local docs recommended Senakot for their patients with constipation issues related to narcotic use. It is important to maintain bowel regularity and not wait until you are already bound up and the need stronger interventions to get things moving again.

I take two senecot tablets a day. The ones that are maximum strength with stool softener and laxative. That usually works pretty good as long as I eat grapes, peaches or other fruit daily. If needed I take miralax on top of that. Also get yourself a box of surgical gloves so you can give yourself a little help when needed. I have a hernia and just can't strain that hard and I'm sure you know about the hemmorhoid's so get some tucks ointment and pads. Sorry-I know gross but there you have it.:)
Brain

New & Desperate
 

Fentanyl 25mcg, cancer survivor:
2 nights ago, my constipation sent me to the ER. The enema given, and shot did finally work, but the Dr said the CT showed severe constipation all the way up over and low in my intestinal track. I'm a longterm mets tonsil cancer survivor with a fibrosed stricture in my esophagus, so my food intake in extremely limited. I'm on 25mcg of fentanyl and it's been my only relief in absurd thoracic pain which Emory neurology is trying to figure out why- myelitis or neuropathy moved to spine. Either way, not being able to swallow anything other than liquid pain meds, my Dr felt fentanyl was the only choice. I'm afraid. I've lost over 10lbs because I know the liquid food is going to harden and I dreaded the fleet- Phillips thing every 4th day. Now, having that stop working has simply broken my spirit. What can I do to jump start myself? I have a bottle of magnesium citrate I'll start this afternoon if I have too. I took 30ml of lactulose and 30ml of Phillips last night- it's not worked this morning. I'm 5'6- 112lbs, unhealthy & tired. I think I'm depressed- I know I'm sad. I hope something helps & would appreciate suggestions. The cramping is horrible & I'm starving (juice & 2 activia yogurts a day). I just need to know this too will pass.