Opioid-Induced Constipation Among Patients with Chronic Noncancer Pain in the United States, Canada, Germany, and the United Kingdom: Laxative Use, Response, and Symptom Burden Over Time

Coyne, Karin S.; Margolis, Mary Kay; Yeomans, Karen; King, F.; Chavoshi, Soheil; Payne, Krista A.; LoCasale, Robert

doi:10.1111/pme.12724

Cited by 82 publications

(91 citation statements)

References 22 publications

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“…These findings, to the best of the authors’ knowledge, have not been reported in any previous studies and may need to be part of the standardized assessments for patients on opioid analgesics. The present survey showed a greater gender bias toward females (78%) than previously reported results …”

Section: Discussioncontrasting

confidence: 78%

Opioid‐Induced Constipation Survey in Patients with Chronic Noncancer Pain

2016

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Chronic pain patients relying on chronic opioid therapy are often challenged with opioid-induced constipation (OIC), a difficult condition to treat that has a significant psychosocial impact on those who are affected (Bruner et al., J Pain Res, 8, 2015, 289). Unlike other side effects of opioids, OIC does not resolve over time during chronic opioid use, and treatments used for functional constipation often fail to provide adequate symptom relief (Nelson and Camilleri, Therap Adv Gastroenterol, 8, 2015, 206). Estimates of the prevalence of OIC vary. It has been reported that 15% to 90% of opioid users are affected by OIC (Gaertner et al., J Clin Gastroenterol, 49, 2015, 9; Wan et al., Am Health Drug Benefits, 8, 2015, 93; Coyne et al., Clinicoecon Outcomes Res, 6, 2014, 269). In addition, a recent rise in opioid prescriptions by nonpain specialists has contributed to the increase in opioid-related side effects, such as OIC (Nelson and Camilleri, Therap Adv Gastroenterol, 8, 2015, 206; Tuteja et al., Neurogastroenterol Motil, 22, 2010, 424). We conducted a survey on OIC through PainPathways magazine in fall of 2014 and in spring of 2015. Survey results showed the prevalence of depression and the modification of opioid dosage were higher than previously thought. Additionally, we found that discussions with healthcare workers regarding OIC do not take place regularly. Our results re-emphasize the need for a consensus on OIC-specific diagnostic criteria, evidence-based treatment strategies, outcome metrics, and education about OIC for both prescribers and patients to improve clinical outcome as well as patient satisfaction.

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Section: Discussioncontrasting

confidence: 78%

Opioid‐Induced Constipation Survey in Patients with Chronic Noncancer Pain

2016

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“…The prevalence of opioid use has risen sharply during the past two decades in response to calls for better pain management for chronic cancer and non‐cancer pain and due to the ageing population. For example, currently more than 3% of American adults suffering from chronic non‐cancer pain receive long‐term opioid therapy . However, concurrently with the greater utilization of opioid therapy, opioid‐induced side effects and adverse effects have become a greater problem, costing US society $560 to $635 billion annually…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…For example, currently more than 3% of American adults suffering from chronic non-cancer pain receive long-term opioid therapy. 1 However, concurrently with the greater utilization of opioid therapy, opioid-induced side effects and adverse effects have become a greater problem, costing US society $560 to $635 billion annually. 2 Opioid-induced constipation (OIC) is one of the most common and troublesome adverse effects (AEs) of pain management with opioids.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Management of opioid-induced constipation in pregnancy: a concise review with emphasis on the PAMORAs

Pergolizzi

Huttner

et al. 2015

J Clin Pharm Ther

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SUMMARYWhat is known and objective: Opioid-induced constipation (OIC) is one of the most common opioid-induced adverse effects. Pregnancy also predisposes to bowel dysfunctions due to the associated endocrine changes. Pregnant women are thus at greater risk of OIC. We review the non-pharmacologic and pharmacologic treatment options as a guide for achieving a clinically optimal strategy for the management of OIC during pregnancy. Methods: The published literature was searched for current therapeutic options, including non-pharmacologic dietary modifications, laxatives, and the peripherally acting mu-opioid receptor antagonists (PAMORAs). Each was assessed for efficacy and safety, particularly as they relate to pregnancy. Results and discussion: Non-pharmacologic approaches such as dietary change are generally safe, but generally insufficient when used alone to control OIC in pregnancy. Laxatives (bulking, osmotic, stimulant) can be effective, but have potential adverse effects that might be particularly troublesome during pregnancy (e.g. electrolyte disturbances, dehydration, abdominal pain, and pulmonary oedema or hypermagnesaemia in the extreme). PAMORAs, which attenuate OIC without affecting opioid-induced analgesia, have been associated with only minimal side effects during the clinical studies to date. What is new and conclusions: Conventional non-pharmacologic and pharmacologic options for the management of OIC in pregnancy are often suboptimal due to insufficient efficacy or adverse effects particularly troublesome during pregnancy. The PAMORA strategy appears to provide a safe and effective new option superior to conventional therapies for the management of OIC during pregnancy. WHAT IS KNOWN AND OBJECTIVEOpioids are commonly prescribed for the management of moderate to severe pain. The prevalence of opioid use has risen sharply during the past two decades in response to calls for better pain management for chronic cancer and non-cancer pain and due to the ageing population. For example, currently more than 3% of American adults suffering from chronic non-cancer pain receive long-term opioid therapy.1 However, concurrently with the greater utilization of opioid therapy, opioid-induced side effects and adverse effects have become a greater problem, costing US society $560 to $635 billion annually. Opioid-induced constipation (OIC) is one of the most common and troublesome adverse effects (AEs) of pain management with opioids.2 It results from opioid-induced agonist action (activation) of opioid receptors, primarily the l (MOR) subtype, located in the gastrointestinal (GI) tract enteric nervous system (ENS) and the central nervous system (CNS).3 Bowel tone and GI transit are reduced by opioids and fluid absorption is enhanced, causing difficulty in rectal evacuation and lumpy, hard stools. Although other opioid receptor types such d (DOR) and j (KOR) contribute to opioid-induced inhibition of gastrointestinal muscle activity, l-opioid receptors are considered the most significant contributors to opioid-indu...

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“…Around half of people admitted into palliative care are reported to experience constipation, with approximately 80% requiring laxatives, especially those taking opioid medications (Fallon andO'Neill, 1998 andSykes, 2013). The use of opioid analgesia, frequently results in gastrointestinal side effects, including constipation with estimates of OIC ranging between 40-60% of patients treated with opioid for noncancer pain, even when laxtive medication is used (Coyne et al, 2015).…”

Section: Prevalence Of Opioid-induced Constipationmentioning

confidence: 99%

“…Constipation is the most common side effect of opioid analgesia, with between 40-90% of patients developing opioidinduced constipation (OIC) (Coyne et al, 2015). Guidelines therefore state that all patients should commence laxatives at the start of opioid therapy and continue throughout their treatment (National Institute for Health and Care Excellence, (NICE) 2016 andBritish Medical Association andRoyal Pharmaceutical Society, 2016 (March)).…”

Section: Introductionmentioning

confidence: 99%

Opioid-induced constipation: Pathophysiology, treatment and management

Bardsley

2016

Nurse Prescribing

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Opioid analgesics are increasingly used to alleviate severe acute and chronic pain. Opioid Induced Constipation (OIC) is the most common side effect of opioid analgesia which can have a significant effect on the persons' quality of life and lead some to decrease or stop taking their analgesia. Although it is recommended that laxative therapy is commenced at the same time as opioid medication, many laxatives do not target the underlying cause of OIC and therefore may be ineffective. As with any patient with constipation other causes should be identified and where possible modified to reduce the risk of OIC. Simple laxatives remain the first line treatment, but there efficacy should be regularly reviewed. Newer opioid antagonist medication should be considered where these are simple laxatives are ineffective.

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Opioid-Induced Constipation Among Patients with Chronic Noncancer Pain in the United States, Canada, Germany, and the United Kingdom: Laxative Use, Response, and Symptom Burden Over Time

Abstract: OIC among noncancer pain patients is a persistent and significant condition with varying utilization and response to laxatives thus increasing the ongoing burden of chronic pain. © 2014 Wiley Periodicals, Inc.

Cited by 82 publications

References 22 publications

Opioid‐Induced Constipation Survey in Patients with Chronic Noncancer Pain

Opioid‐Induced Constipation Survey in Patients with Chronic Noncancer Pain

Management of opioid-induced constipation in pregnancy: a concise review with emphasis on the PAMORAs

Opioid-induced constipation: Pathophysiology, treatment and management

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