Determining patient treatment preferences for management of acute pain episodes in irritable bowel syndrome

Abstract

Background: Many patients with irritable bowel syndrome (IBS) experience acute and unexpected pain episodes over and above chronic background symptoms, and there are emerging medications designed to treat such pain. We aimed to use conjoint analysis-a technique that elucidates how people make complex decisions-to examine patient preferences for emerging medicines for breakthrough IBS pain. Methods:We conducted a cross-sectional conjoint analysis survey among patients with Rome IV IBS and recurrent episodes of acute pain to assess the relative importance of medication attributes in their decision-making. We also assessed what respondents would require of subcutaneous (SQ) therapies to consider their use.Key Results: Among 629 patients with Rome IV IBS, 606 (96.3%) reported ≥1 acute pain episodes in the past month. For the 461 participants with multiple attacks who completed the conjoint analysis, they prioritized medication efficacy (importance score 34.9%), avoidance of nausea (24.3%), and avoidance of constipation (12.2%) as most important in their decision-making. These were followed by route of administration (10.3%), avoidance of headache (9.3%), and avoidance of drowsiness (8.9%).Moreover, 431 (93.5%) participants would consider SQ therapies for their acute pain; they had varying expectations on the minimum pain decrease and onset and duration of pain relief needed for considering their use. Conclusions and Inferences:The vast majority of patients with IBS experience breakthrough pain, and when selecting among therapies, they prioritize efficacy and most are willing to use a rapid-acting SQ treatment. These results support development of novel, effective medications-oral or SQ-for management of acute pain attacks. K E Y W O R D Sabdominal pain, irritable bowel syndrome, oral, patient preference, subcutaneous Key Points • Many patients with irritable bowel syndrome (IBS) experience acute pain episodes over and above chronic background symptoms. In this study, conjoint analysis was used to examine patient preferences for emerging medicines for breakthrough IBS pain, modeling both oral and subcutaneous (SQ) therapy options.

Global patterns of prescription pain medication usage in disorders of gut–brain interactions

“…In a recent analysis of US gastroenterologist prescribing patterns, 10% of outpatient GI visits were associated with an opioid prescription and less than a quarter of gastroenterologists wrote more than 10 neuromodulator prescriptions annually 22 . While neuromodulators are central for the treatment of pain within the context of DGBIs, many patients still experience breakthrough pain and novel non‐opioid medications for management of acute pain attacks are still needed 23 . In addition, the advent of brain–gut behavioral therapies has expanded our treatment armamentarium for DGBI; the robust science supporting a mechanistic link to the brain–gut axis has shown the benefit of non‐pharmacologic therapies in comprehensive pain management 24 .…”

“… 22 While neuromodulators are central for the treatment of pain within the context of DGBIs, many patients still experience breakthrough pain and novel non‐opioid medications for management of acute pain attacks are still needed. 23 In addition, the advent of brain–gut behavioral therapies has expanded our treatment armamentarium for DGBI; the robust science supporting a mechanistic link to the brain–gut axis has shown the benefit of non‐pharmacologic therapies in comprehensive pain management. 24 Brain–gut psychotherapies can be highly customized, can be used across the spectrum of painful DGBI and augment the effect of pharmacologic treatments.…”

“…22 While neuromodulators are central for the treatment of pain within the context of DGBIs, many patients still experience breakthrough pain and novel non-opioid medications for management of acute pain attacks are still needed. 23 In addition, the advent of brain-gut behavioral therapies has expanded our treatment armamentarium for DGBI;…”