Opioid‐Induced Constipation Survey in Patients with Chronic Noncancer Pain

Abstract

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.

Patients' Self-Assessment of the Symptoms and Impact of Opioid-Induced Constipation: Results From a Prospective Observational Cohort Study of Japanese Patients With Cancer

“…Some studies have reported communication gaps between patients and HCPs related to OIC, in part because patients are embarrassed to discuss bowel symptoms, HCPs are underestimating the burden of OIC, patients are having varying perceptions of constipation, and nonpain specialists are increasingly prescribing opioids. 8,27,38,39 However, in the present study, most patients and HCPs reported that OIC-related topics were ''sufficiently'' or ''essentially communicated.'' This finding suggests that the tools used in this study may be effective for facilitating better patient-provider communications about OIC.…”

“…Along these lines, longer evaluations of patient perceptions of OIC and the impact of OIC on pain management are warranted, especially because, unlike many other side effects of opioid therapy, OIC does not diminish over time. 13,38 In addition, nonpharmacological 2.0 0 1. lifestyle modifications that can alleviate constipation for some patients, such as increased exercise, dietary changes, and increased fluid intake, are not feasible for many patients with advanced-stage cancer. Such patients may have limited mobility, diet, and overall physical functioning.…”

Prolonged-release oxycodone/naloxone reduces opioid-induced constipation and improves quality of life in laxative-refractory patients: results of an observational study

“…OIC negatively impacts patients’ quality of life (QoL), 9 – 11 affecting their relationships, social life, dietary choices and ability to perform activities of daily living. 11 To avoid OIC, some patients will reduce their opioid dose, or even stop taking opioids altogether, which can result in uncontrolled pain. 9 – 12 Almost half of the 439 patients in a multinational survey reported that OIC moderately or completely interferes with pain control.…”

“…There is also a considerable economic burden associated with OIC: patients may need time off work or be less productive when at work, 10 , 11 and may use additional health care resources. 15 In Sweden and the US, it has been shown that total health care costs are significantly higher for patients with OIC than for those without.…”

Treating opioid‐induced constipation in patients taking other medications: Avoiding CYP450 drug interactions

“…3,11 In all cases, OIC results in a decreased quality of life and lost work productivity. 3,[12][13][14][15] There can also be serious medical sequelae, including pain ("painstipation" 3 ), haemorrhoids, anal fissure, organ prolapse, bowel obstruction and perforation, and peritonitis, among others. 16 All of these have a large negative impact and cost to the patient, provider and healthcare system.…”