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

Abstract

Introduction: Opioids are a valuable tool to help achieve control of pain. However, opioid-induced 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 non-cancer 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.

Keywords: Cancer; Impact; Opioid-induced constipation; Opioids; Pain; Survey.

Fig. 1

PROMIS global physical health, mental health, and pain interference scores. For global physical health and mental health, a higher score indicated better health, while for pain interference a higher score indicated more interference

Fig. 2

PAC-SYM and PAC-QoL scores in patients with chronic non-cancer pain and cancer pain. A higher score indicates greater impact. The sample size was too small for analysis by strong vs. weak opioids in cancer pain since most patients were receiving strong opioids. There was no significant difference in PAC-QoL score between chronic pain and cancer pain

Fig. 3

OIC in patients with cancer (n = 100) or chronic pain (n = 296)

Fig. 4

Methods used to manage constipation in chronic or cancer patients

Fig. 5

Satisfaction with constipation management techniques. Patients with non-cancer pain (a). Patients with cancer pain (b)

Fig. 6

Extent to which constipation affects ability to adhere to opioid regime and changes in pain relief after experiencing constipation

Fig. 7

Changes to opioid regimen in patients with OIC

Fig. 8

Overall satisfaction with overall management of OIC by the healthcare system (a). Details about satisfaction in all patients with chronic pain (b). Changes made to opioid regimen in patients who were not warned about constipation (c)