Impact and Consequences of Opioid-Induced Constipation: A Survey of Patients

Varrassi, Giustino; Banerji, Vivek; Gianni, Walter; Marinangeli, Franco; Pinto, Carmine

doi:10.1007/s40122-021-00271-y

Cited by 15 publications

(10 citation statements)

References 33 publications

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“…It is also plausible that patients may forget or hesitate to ask their healthcare providers until OIC symptoms become prominent and bothersome. Therefore, healthcare providers should be encouraged to actively ask patients about OIC at every follow-up visit [ 24 ]. To that effect, educating healthcare providers and patients about the burden of OIC and the overall benefit-to-risk ratios of opioid analgesics is important.…”

Section: Discussionmentioning

confidence: 99%

A Survey of the Incidence of Constipation in Patients with Chronic Non-cancer Pain Using Opioid Analgesics in Japan

et al. 2022

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Introduction Although opioids have potent analgesic properties, their use is associated with side effects, including opioid-induced constipation (OIC). This study investigated the incidence of OIC based on the Rome IV diagnostic criteria in patients using opioid analgesics for chronic non-cancer pain and to explore and compare the risk factors for the development of OIC in opioid analgesic users. Methods We surveyed patients aged 20 years or more living in Japan via the internet; who had been using opioid or non-opioid analgesics ( N = 500 each) for at least 3 months for relief from chronic non-cancer musculoskeletal pain (low back pain or osteoarthritis); and who provided electronic consent to participate in and complete the survey. The groups were matched for age and sex. Results Of the patients using opioid analgesics, 89% were taking weak opioids. The proportion of patients perceiving constipation was comparable between the opioid and non-opioid analgesic groups (34% vs 29%, respectively); however, a significantly higher proportion of patients in the opioid group, compared to the non-opioid group, reported self-assessed constipation (40% vs 18%, respectively) after using an analgesic and fulfilled two or more symptoms of the Rome IV diagnostic criteria for constipation (28% vs 19%, respectively). A higher proportion of patients were taking prescribed medicine for constipation in the opioid group compared with the non-opioid group (33% vs 18%, respectively). Low back pain, but not opioid strength and scheduled dosing, was identified as a risk factor for OIC among various covariates assessed in the logistic regression analysis in 81 patients with OIC and Rome IV diagnosis vs 419 patients without OIC in the opioid group. Conclusion Use of opioid analgesics, including weak opioids, for treating chronic non-cancer musculoskeletal pain is associated with OIC. This finding highlights the need for appropriate treatment of constipation in patients with chronic non-cancer pain in Japan. Trial Registration UMIN000043985. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-022-00392-y.

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Section: Discussionmentioning

confidence: 99%

A Survey of the Incidence of Constipation in Patients with Chronic Non-cancer Pain Using Opioid Analgesics in Japan

et al. 2022

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“…Opioid-induced constipation has a negative impact on patients' quality of life (QoL) and comfort level (Bell et al, 2009;Varrassi et al, 2021). Around 38% -95% of patients with cancer with OIC have reported poor (QoL) (Abramowitz et al, 2013;Al-Daken and Ahmad, 2018;Panchal et al, 2007;Veiga et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Some patients decrease or discontinue opioid medication to minimize constipation, thus, weakening the analgesic effect and impaired QoL (Christensen et al, 2016). As a result, OIC management became difficult and did not reach patient satisfaction (Ahmad et al, 2010;LoCasale et al, 2016;Varrassi et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Constipation Severity and Quality of Life among Patients with Cancer Who Received Prophylactic Laxatives: Quasi-Experimental Study

Ahmad¹,

Alnaeem²

2022

Asian Pac J Cancer Prev

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Background: Prophylactic laxatives were associated with decreasing the incidence of Opioid-induced constipation among patients with cancer. This study aims to evaluate the effectiveness of early prophylactic laxatives therapy on the severity of constipation and quality of life among patients with cancer receiving opioids. Methods: Using a quasiexperimental design with 64 patients assigned to control group and 66 patients assigned to intervention group. The final sample was composed from 112 patients (57 in control group and 55 in intervention group), who were selected from an oncology clinic. Patients in the intervention group have received prophylactical laxatives The intervention included an oral colonic stimulant laxative (i.e., Bisacodyl, Dose= 3 tab/ day and/or Senna 6.8 mg twice daily) and an oral colonic osmotic laxative (i.e., Lactulose, Dose = 15 ml three times per day). Patients in the control group continue to receive their routine care without laxatives. Results: Patients in the intervention group have reported a significant reduction in the severity of constipation symptoms at eight weeks post the intervention (p < 0.001). Furthermore, the patients in the intervention group have revealed a significant improvement in their quality of life (QoL) (p< 0.001). Conclusions: Patients with cancer need to use the first line of laxatives as prophylactic alongside with opioids to minimize the severity of Opioid-induced constipation symptoms and to enhance the QoL.

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“…Among their common side effects, the most bothersome and debilitating are those associated with opioid-induced bowel dysfunction (OIBD). This includes opioid-induced constipation (OIC) [2,3], defined as a change in baseline bowel habit or defecatory patterns following initiation, modification, or increase of opioid therapy [1]. OIC is a common side effect, yet under-recognized and under-treated [2].…”

Section: Introductionmentioning

confidence: 99%

“…This includes opioid-induced constipation (OIC) [2,3], defined as a change in baseline bowel habit or defecatory patterns following initiation, modification, or increase of opioid therapy [1]. OIC is a common side effect, yet under-recognized and under-treated [2]. This ongoing burden emphasizes the need to identify more efficacious constipation therapies for the chronic pain patient population treated with opioids [4] as effective pharmacologic therapy for OIC is considered an unmet need [3].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Peripherally Acting μ-Opioid Receptor Antagonist (PAMORAs) for the Management of Patients With Opioid-Induced Constipation: A Systematic Review

Rekatsina

Paladini

Drewes

et al. 2021

Cureus

Self Cite

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In treating chronic and acute pain, opioids are widely used. Although they do provide analgesia, their usage does come with adverse events (AEs). One of the most burdensome is opioid-induced bowel dysfunction, and more specifically opioid-induced constipation (OIC). The pathogenesis of these AEs is well known as the consequence of the action of opioids on m-receptors in the enteric nervous system. In recent years, medicines counteracting this specific action at the receptors have been registered for clinical use: the peripherally acting μ-opioid receptor antagonists (PAMORAs). The knowledge of their comparative efficacy and tolerability is very important for physicians and patients in opioid therapy. This systematic review of the existing literature on PAMORAs aimed to study the relative clinical advantages and disadvantages.The most important data banks, including "PubMed," "Embase," "CT.gov," "ICTRP" and "CINAHL" were used to find the published material on PAMORAs. The selected publications were examined to systematically analyze the efficacy and safety of the four existing PAMORAs.All of the medications are superior to placebo in reducing OIC. There are few published data on alvimopan used to treat OIC, and it is only indicated for the treatment of post-abdominal surgery ileus. Methylnaltrexone is studied mainly in its subcutaneous (SC) formulation. When used in its oral formulation, it seems more rapid than naloxegol and placebo in the reduction of OIC. Naldemedine is able to produce more spontaneous bowel movements (SBMs) when compared to alvimopan and naloxegol.Tolerability was found to be similar for all of them. In particular, they affect the gastrointestinal tract (GI), with flatulence and diarrhea, especially at high dosages. For some of them, nasopharyngitis and abdominal pain were observed as treatment adverse effects (TEAs). Several cardiovascular TEAs were reported after methylnaltrexone use, but it is not clear whether they were consequences of the drug or related to the general conditions of the patients.Considering the existing data, naloxegol and naldemedine seem to be the best choices, with a higher number of spontaneous bowel movements following naldemedine administration.

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Impact and Consequences of Opioid-Induced Constipation: A Survey of Patients

Cited by 15 publications

References 33 publications

A Survey of the Incidence of Constipation in Patients with Chronic Non-cancer Pain Using Opioid Analgesics in Japan

A Survey of the Incidence of Constipation in Patients with Chronic Non-cancer Pain Using Opioid Analgesics in Japan

Constipation Severity and Quality of Life among Patients with Cancer Who Received Prophylactic Laxatives: Quasi-Experimental Study

Efficacy and Safety of Peripherally Acting μ-Opioid Receptor Antagonist (PAMORAs) for the Management of Patients With Opioid-Induced Constipation: A Systematic Review

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