All backed up; opioid induced constipation

274783-main_FullConstipation is often a side effect of opioid use. It seems like you can never win. You take one medication to get rid of your pain, and then another one to get rid off all the side effects. It is estimated that out of all the patients who taken opiates for chronic pain, 40-90% will develop constipation. ( Via) There are many medications that your doctor can prescribe to you. Just like all medication regimens, finding the perfect cocktail is always a challenge.
Of course, when it comes to your bowel, this challenge is not always a fun one.

Besides what your doctor tells you, there are many things you can do to help yourself.
Diet and overall lifestyle changes will have a big impact on your GI system.
Try to make sure you:

• Increase the amount of fluid you drink per day.

• Eat more fiber. If this is difficult try adding a fiber wafer to your morning meal. Remember fiber doesn’t always mean oatmeal and whole grains. Fresh vegetables and fruits are wonderful sources of fiber, especially pears, apples, bananas, raspberries, and oranges!

• Get moving! Increase your exercise and daily activity.

• Allow time for privacy on the toilet. Also, stock you bathroom with good things to read. After all, if you are going to be in there awhile, might as well read a trashy novel or two!

If your stomach hurts from being bloated, try taking a hot bath, or using a hot water bottle. I move the hot water bottle from my stomach to my lower back from time to time.

Another trick to get things moving is to gently massage your stomach in small circles in a clockwise rotation. Start below your ribcage and work your way around. You will not need to use much pressure. This massage helps to get your intestines moving. It feels best for me after I take a hot bath when my body is a little more relaxed.

Herbs:
Just like western medications, there are many herbs that can help or hurt your medical situation. And should be taken only under the advisement of a medical professional. Some western medications can be affected by relatively what seem to be harmless eastern herbal remedies.

New advances in medicine are happening daily! There are now medications made specifically for people affected with opioid induced constipation (OIC). If you have been taking opioids for a while because of your chronic pain, one of these two medications just might help.

Methylnaltrexone (available as Relistor(R)) helps restore bowel function in patients.” It is delivered via subcutaneous injection and specifically targets opioid-induced constipation. When given alongside opioid therapy, it is designed to displace the opioid from binding to peripheral receptors in the gut, decreasing the opioid’s constipating effects and inducing laxation. Methylnaltrexone blocks peripheral opioid receptors in the gut and unlike other opioid antagonists has restricted ability to cross the blood-brain barrier. As a result, it antagonizes only the peripherally located opioid receptors in the GI tract, so it’s action reverses opioid-induced constipation without precipitating withdrawal symptoms or affecting or reversing the central analgesic effects of opioids .” (Via)

Another medication, brand name Targinact, combines the extended released opioid Oxycodone with extended release Naloxone to help the GI tract. This combination is a wonder duo! Naloxone is most commonly used to counter the effects of opioid overdose. Naloxone is an opioid receptor competitive antagonist. (Not to be confused with Naltrexone, which is an opioid receptor antagonist with qualitatively different effects, used for dependence treatment. Low-dose Naltrexone is in pain study trails at Stanford right now. Read my posting about the study.) By being an opioid receptor competitive antagonist, “Naloxone provides an inability for the opioid receptor to have an effect on the gut, counteracting opioid-induced constipation – without impacting on the centrally acting analgesic efficacy of oxycodone.” (Via) It binds to the receptor so that it does not bind to your gut.
Science just keeps improving!
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A major drug deal was signed this week between AstraZeneca and Nektar Therapeutics for the continued development of NKTR-118 and NKTR-119 programs. Both of these studies are something to watch out for in the near future. NKTR-118 is drug still in its testing phrase “that combines Nektar’s advanced small-molecule polymer conjugate technology platform with naloxol, a derivative of the opioid-antagonist drug naloxone.” (Via) NKTR-119 combines the drug from NKTR-118 and determines what opioid combination will work best with it to help eliminate constipation associated with opioid usage.

AstraZeneca and Nektar are both major players in the pharmaceutical market. It will be exciting to see what this new partnership will bring to the table!

Until then, make sure you eat right, drink plenty of water, and consult your doctor if you have any questions about what you can do for your GI system.

For further reading check out:

What’s the Best Source of Fiber: The Diet Channel

Scientific America

Medscape

University of Maryland Medical Center

Cooley Team

Also take the time and read this great blog about how you can take care of your intestines on Lumigrate.

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Stanford Tests T3 for the Treatment of Fibromyalgia

nav_imageStanford Systems Neuroscience and Pain Lab does it again. Dr. Ian Carroll, MD, MS, and Dr. Jarred Younger, PhD are currently enrolling patients now in a new clinical trial to help fibromyalgia patients. Dr. Younger also worked on Stanford’s research of low dose Naltrexone for the treatment of fibromyalgia.

Stanford says on their site:(via)
“We are investigating whether the thyroid hormone T3 is one such treatment that may alleviate the symptoms of Fibromyalgia. There is significant overlap between the symptoms ofhypothyroidism (low thyroid hormone production), depression, chronic fatigue, and Fibromyalgia. Patients with low thyroid hormone production who have been treated with T3 for depression have had some improvement in symptoms.

This is the first study to examine whether T3 may help with the symptoms of Fibromyalgia. Studies such as this are a necessary step to having an investigational drug become a mainstream treatment. Your participation is a vital part of the search for an effective Fibromyalgia treatment.”

To understand how your thyroid works, here’s a great site:www.endocrineweb.com/thyfunction.html

I also found out about Dr. John C. Lowe. Here is a great interview with him about the subject on about.com.

To see any other clinical trials going on, looking at the clinical trials.gov page is always a good place stop.
Look here to see what they have to say about the study.

Click here to see Stanford enrollment form -> http://snapl.stanford.edu/t3/

Also, check out Lumigrate’s educational video: Hypothyroidism: Misunderstood, Misdiagnosed, Missed! by Dr. Scott Rollins lum-hypothyroid_0

Study of Naltrexone effects continues

Researchers at Standford are now into their next stage of clinical trials of looking at low doses of Naltrexone for use with fibromyalgia patients. The first study which was implemented early in 2007 showed hope that Naltrexone might work for fibro patients with little side effects. Typically, Naltrexone is used in 50 mg dose to help treat alcohol and opiate addiction. They tested the drug for fibro in a very low dose, around to 4.5 mg. Instead of blocking the bodies pain receptors, the dosage of the medication “modulated activity of glial cells to act as a neuroprotectant and suppressant of proinflammatory cytokines”. (medpagetoday) The study was lead by Jarred Younger, PhD and Sean Mackey, MD, PhD. Here’s a great chart showing their results:
ldn
“Overall, self-reported, daily fibromyalgia symptoms (scale 0 – 100, with 100 being most severe symptoms). Time periods are: baseline, placebo, LDN, and washout. The data are separated into drug responders (solid line, 6 people) and drug nonresponders (broken line, 4 people). Drug responders are individuals who had at least a 30% greater reduction of symptoms during LDN versus placebo.” -stanford.edu

Hopefully by the end of this year we will know if the dug will help those of us with fibromyalgia.

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Link to Stanford post

ResearchChannel – An Update on Fibromyalgia

Here’s a great lecture from The Standford University Medical Center Health Hour:
ResearchChannel – An Update on Fibromyalgia

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