Prevalence and clinical features of opioid-induced constipation in the general population: A French study of 15,000 individuals

Abstract

Background: Constipation is common during opioid therapy and can compromise analgesia.

Aim: The aim of this article is to determine the prevalence and clinical characteristics of opioid-induced constipation (OIC) in France.

Methods: A questionnaire study was conducted in a representative sample of the French general population. Participants completed a 31-item questionnaire covering opioid use during the previous six months, and the occurrence of constipation (defined as <3 bowel movements per week, straining during defaecation, or both) during opioid treatment.

Results: Data were obtained from 15,213 participants, of whom 4753 (31.2%) reported opioid use. Most analgesics (96.5%) were classified as World Health Organization step II analgesics, and the remainder were step III. The most common indications for opioids were bone or joint pain, and soft tissue pain. Overall, 414/4753 (8.7%) opioid users reported OIC while the prevalence of OIC reached 21% in case of regular or prolonged (>1 month) opioid use. Other characteristics associated with OIC included female gender, age ≥50 years and use of step III opioids. Only 177/414 (42.8%) participants with OIC had used medications (most commonly osmotic laxatives) to treat constipation, and satisfaction with constipation medication was moderate (mean (SD) score 7.2 (1.3) on a scale of 0-10).

Conclusions: Approximately one-third of a representative French population had used opioids within the previous six months, and 9% of users had experienced OIC, which is more frequent in case of regular use. OIC appears to be under-treated, and participants' satisfaction with their constipation medications was only moderate, suggesting that significant unmet need remains in OIC management.

Keywords: Constipation; observational study; opioids; pain; side effects.

Figure 1.

Principal indications for opioid treatment.

Figure 2.

Indications for opioid treatment in opioid users with (n = 414) and without (n = 4339) constipation. ^ap < 0.05 versus opioid users without constipation.

Figure 3.

Reasons for non-use or discontinuation of medication for constipation among opioid users. n = weighted/unweighted values. For patients who had stopped medication for constipation, we have given only the three main reasons of discontinuation; therefore, the overall percentage is not 100%. For the remaining patients, reasons of discontinuation were miscellaneous.