Bowel dysfunction, especially opioid-induced constipation, is one of the most common and persistent side effects in treatment of moderate to severe chronic pain with opioid analgesics.

This results in reduced treatment efficacy and low treatment compliance; patients are exposed to additional burden and stress. Innovative combination of opioids oxycodone/naloxone was shown to be a solution for the unmet need of chronic pain treatment.

Katri Elina Clemens and Gerd Mikus from the Centre for Palliative Medicine at the University of Bonn say that combined oral oxycodone/naloxone efficiently reduces moderate to severe non-malignant chronic pain, has a beneficial effect on bowel function and is well tolerated (Expert Opinion on Pharmacotherapy 2010; 11(2): 297-310).

A recent study carried out by Dr Clemens and her team has shown that also patients with moderate to severe chronic cancer related pain can benefit considerably, if pain is alleviated with prolonged release tablets and a combination of oxyicodone and naloxone.

In a non-randomised, open, monocentric study, bowel function was assessed in palliative patients, treated with the aforementioned combination. Before switching to pain treatment with oxycodone/naloxone, all patients had already had opioid-induced constipation.

As early as within the first 14 days, the constipation symptom severity was significantly reduced from 72 to 36 (100 means very severe constipation, 0 means absence of constipation). In patients receiving a combination of oxycodone/naloxone, the pain severity level was progressively reduced, at the same time bowel function was improving and overall patient satisfaction was increased.

Appropriate treatment with the oxycodone/naloxone combination successfully alleviates pain without causing additional constipation, avoiding or preventing the negative aspects of treatment with laxatives at the same time (International Journal of Clinical Practice 2011; 65(4): 472-478).

The said combination has already been registered in Slovenia and will soon be available to Slovenian patients who suffer from various types of chronic pain.