American Board of Internal Medicine (ABIM) Certification Practice Exam

What unexpected physical condition can opioid therapy lead to, necessitating the need for a laxative?

1. Weight loss

2. Constipation

3. Nausea

4. Headaches

The correct answer is: Constipation

Opioid therapy is well-known for its side effects, particularly the development of constipation. This happens because opioids bind to receptors in the gastrointestinal tract, which slows down peristalsis—the wave-like muscle contractions that move food through the intestines. The result is a delay in bowel movements and increased absorption of fluids from the bowel, leading to hard and dry stools. Due to this risk, healthcare providers often recommend the concurrent use of laxatives when starting opioid therapy to manage and mitigate this side effect. Patients on long-term opioid therapy are particularly vulnerable to constipation, which can have a significant negative impact on their quality of life. Recognizing this relationship between opioid use and constipation is essential for both prescribers and patients to ensure comprehensive and safe pain management. Weight loss, nausea, and headaches can occur as side effects of opioids or other conditions but do not specifically necessitate the use of laxatives in the same way that constipation does. Thus, while they are important considerations in managing a patient's overall health while on opioids, they do not share the direct and well-established link that constipation has with opioid therapy.