The patient burden of opioid‐induced constipation: New insights from a large, multinational survey in five European countries

Abstract

Background Despite its high prevalence, opioid-induced constipation (OIC) remains under-recognised and undertreated, and its true impact on wellbeing and quality of life (QoL) may be underestimated. Methods A quantitative, questionnaire-based international survey was conducted. Results Weak-opioid users appeared as bothered by constipation as strong-opioid users (38% vs 40%, respectively; p = 0.40), despite it causing less-severe physical symptoms and impact on QoL. Strong-opioid users meeting Rome IV OIC criteria appeared to experience greater symptomatic and biopsychosocial burden from constipation than those not satisfying these criteria. Almost one-fifth of respondents were dissatisfied with their current constipation treatment and around one-third found balancing the need for adequate pain relief with constipation side effects challenging. Consequently, more than half failed to adhere to their prescribed treatment regimens, or resorted to suboptimal strategies, e.g. 40% reduced their opioid intake, to relieve constipation. Almost 60% of healthcare professionals did not adequately counsel patients about constipation as a common side effect of opioid use. Conclusions Findings suggest that both weak- and strong-opioid users suffer comparable bother and decreased QoL, Rome IV criteria can identify patients with more-severe OIC, but may underdiagnose patients showing fewer symptoms, and increased education is needed to manage patients’ expectations and enable improved OIC self-management.

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.…”

“…Consistent with previously published reports, the quality of BMs, including straining, sensations of incomplete evacuation, and stool hardness, as well as abdominal, emotional, and psychological symptoms, are important criteria that patients associate with the burdens of OIC and reduced QOL. 8,27,36,37 Therefore, patients' self-assessments are crucial for measuring the burden of OIC, further highlighting the importance of communication between patients and HCPs.…”

“…Patients may find the physical and emotional symptoms of OIC to be debilitating, resulting in significant impairment in patients' health-related QOL, ability to perform daily activities, and overall sense of wellbeing. 9,22,27 Despite the availability of prescription and over-thecounter medications to treat constipation, many drugs have limited efficacy because they do not target the underlying pathophysiology of OIC. 13,15,28 Newer agents, such as peripherally acting m-opioid receptor antagonists (PAMORAs), have the potential to improve patient outcomes because they provide a more targeted treatment than laxatives.…”

Ambulatory assessment of colonic motility using the electromagnetic capsule tracking system: Effect of opioids

“…Male participants were the preferred choice in the current study to avoid alterations in gut function during the female menstruation cycle. 35 The administered opioid doses were chosen to be ethically justifiable with a hypothesized constipating effect. However, longer treatments or higher dosages would plausibly cause more severe GI symptoms.…”

Healthcare professionals´ experiences of assessing, treating and preventing constipation among older patients during hospitalization: An interview study

“…The healthcare professionals indicated that they were highly motivated to work with constipation in a preventive way, but were reliant on organizational resources, such as time and availability of staff, in order to meet the patients' individual needs. Having enough knowledge and time to assess and prioritize the topic of constipation was also found to be important in a study by Saga, Seim, Morkved, Norton and Vinsnes (34) and might be related to organizational prioritization (41,50). In the interviews, the healthcare professionals reported that it was important to be aware of patients' risk factors and the consequences that constipation can lead to.…”