Jornal de Toxicologia Clínica
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Synergic Effects of Acupuncture and Clinical Lactulose Therapy on Opioid-Induced Constipation

Changhui Han, Yingjuan Liu, Dehui Li, Zhihua Du, Pan Ma, Limin Wang, Liying Wei , Huanfang Fan

Background: Opioid-Induced Constipation (OIC) is one of the most common types of complications affecting patients following opioid treatment for cancer pain. Lactulose has been shown to be an effective drug for managing OIC symptoms in clinics. Acupuncture is a non-invasive approach for relieving constipation and pains. However, the co-applications of Acupuncture and Lactulose for OIC have been rarely evaluated.

Materials and methods: To confirm the advanced therapy effects of Acupuncture and Lactulose co-application, 80 OIC patients in Hebei Province Hospital of Chinese Medicine are included in the randomised clinical trial. Two groups were assigned, including the co-application group with Manual Acupuncture and oral lactulose (AC-LA group) and the control group of pure oral Lactulose Administration (LA group). Forty patients are allocated into each group randomly. Scores of pain, symptoms, and Quality Of Life (QOL) at Day 0 (the day before treatment), Day 7, and Day 14 of treatments are recorded to evaluate the outcomes of OIC therapy in both the AC-LA and LA group.

Results: Compared with pure oral lactulose treatment, the combined Manual Acupuncture sessions produced a higher effective rate after seven days (LA 60.53% vs. AC-LA 89.47%, P<0.001) and 14 days (LA 76.32% vs. AC- LA 92.11%, P=0.081) of treatment. The overall symptom scores of the AC-LA group reduced by more than the LA group following one week (LA 18.5% vs. AC-LA 33.6%, P<0.05) or two weeks (LA 39.5% vs. AC-LA 55.8%, P<0.05) of treatment with Manual Acupuncture. Along with the reduced overall symptom scores, the symptoms of defecation straining, harder stool, extended defecation time and intervals, and the feeling of incomplete defecation were relieved in both LA and AC-LA groups. Acupuncture enhanced the remission effects of each constipation sub- symptoms. Though the KPS quality of life scores did not improve significantly, additional acupuncture treatment helped relieve pain in cancer patients (Day 0 6.89 ± 1.66 vs. Day 14 6.05 ± 1.43, P=0.020).

Discussion and conclusion: As a non-invasive approach, acupuncture put on add-up effects for oral lactulose treatment in relieving Opioid-Induced Constipation symptoms. The co-application of acupuncture and lactulose is a considerably better strategy for pain and constipation management of cancer patients in clinics.