Analysis of Patient–Provider Interactions Regarding the Burden and Treatment of Opioid-Induced Constipation in Adults with Chronic Noncancer Pain

Vallerand, April Hazard; Hendry, Sarah; Baldys, Elizabeth; Hu, Yiqun; Datto, Catherine

doi:10.1093/pm/pny151

Cited by 12 publications

(8 citation statements)

References 15 publications

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“…Similar to the results seen herein, in a previous survey more than half of patients were not adequately counseled about constipation, and as a consequence altered their opioid regimen to compensate for OIC [ 20 ]. Along these lines, a retrospective analysis of 216 patient–provider discussions in the United States also found that HCP counseling and management of OIC was inadequate, and that in around 30% of cases no specific treatments or guidance was given [ 30 ]. Our findings mirror those results, since a prescription for OIC was given in only around one-third of cases.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Introduction: Opioids are a valuable tool to help achieve control of pain. However, opioidinduced constipation (OIC) is an important limitation of treatment with this class of drugs. Methods: To better understand the impact of OIC on patient-reported outcomes, we carried out a survey involving patients being treated with opioids. Both ad hoc questions and the PROMIS and PAC-SYM and PAC-QOL scores were used. Results: Of the 597 participants, 150 (25%) had cancer-related pain, and 447 (75%) had noncancer pain; 66% experienced OIC. PROMIS pain interference questions indicated that pain is more likely to interfere with a patient's life when they have OIC. PAC-QOL and PAC-SYM revealed that 58% of patients with non-cancer pain and OIC reported at least one ''severe'' or ''very severe'' constipation symptom, compared to 83% with cancer-related pain. Younger age and less time on opioids were associated with greater impact of OIC on quality of life. Only 41% of patients were satisfied with how their constipation was managed. Over 50% of those with non-cancer pain said that they modified their opioid regimen due to constipation, vs. 6% of those with cancer pain. Constipation had been discussed with the healthcare provider (HCP) in 48% of non-cancer patients and in 73% of cancer patients. In those with chronic pain and OIC, 24% expressed varying degrees of dissatisfaction with the healthcare system, vs. 37% in those with cancer pain and OIC. Conclusion: Our results provide additional evidence that management of OIC is inadequate in many cases. Moreover, they indicate that there is a definite need for better education about OIC among HCPs.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…20 This strategy was intended to increase the sensitivity for detecting patients with constipation, considering some patients using laxatives may not have been diagnosed as such in the EMR, as a previous study found that many patients do not discuss constipation with their medical provider. 46 Another related benefit is that this strategy may identify patients taking laxatives for constipation related to a “constipation only” form of IBS, which was not included in the constipation outcome.…”

Section: Methodsmentioning

confidence: 99%

Association between radicular low back pain and constipation: a retrospective cohort study using a real-world national database

Trager

Mok

Schlick

et al. 2021

PR9

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“…A recent large-scale analysis of a database of more than 100,000 patient-provider conversations revealed that patient education was largely insufficient in a majority of cases with only 1 in 10 patients with OIC discussing the problem with the healthcare provider. Furthermore, it was found that specific action was recommended only in a disconcerting one third of these cases [22].…”

Section: Main Bodymentioning

confidence: 99%

Opioid-induced constipation: a narrative review of therapeutic options in clinical management

Lang-Illievich

Bornemann‐Cimenti

2019

Korean J Pain

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Pain therapy often entails gastrointestinal adverse events. While opioids are effective drugs for pain relief, the incidence of opioid-induced constipation (OIC) varies greatly from 15% to as high as 81%. This can lead to a significant impairment in quality of life, often resulting in discontinuation of opioid therapy. In this regard, a good doctor-patient relationship is especially pivotal when initiating opioid therapy. In addition to a detailed history of bowel habits, patient education regarding the possible gastrointestinal side effects of the drugs is crucial. In addition, the bowel function must be regularly evaluated for the entire duration of treatment with opioids. Furthermore, if the patient has preexisting constipation that is well under control, continuation of that treatment is important. In the absence of such history, general recommendations should include sufficient fluid intake, physical activity, and regular intake of dietary fiber. In patients of OIC with ongoing opioid therapy, the necessity of opioid use should be critically reevaluated in terms of an with acceptable quality of life, particularly in cases of non-cancer pain. If opioids must be continued, lowering the dose may help, as well as changing the type of opioid. If these measures do not suffice, the next step for persistent OIC is the administration of laxatives. If these are ineffective as well, treatment with peripherally active μ-opioid receptor antagonists should be considered. Enemas and irrigation are emergency measures, often used as a last resort.

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Analysis of Patient–Provider Interactions Regarding the Burden and Treatment of Opioid-Induced Constipation in Adults with Chronic Noncancer Pain

Cited by 12 publications

References 15 publications

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

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

Association between radicular low back pain and constipation: a retrospective cohort study using a real-world national database

Opioid-induced constipation: a narrative review of therapeutic options in clinical management

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