Trend Watch

Patients Require Education About Opioid-induced Constipation

Half of patients surveyed reported their physician did not discuss constipation as a side effect of opioid medication or did not recall such discussion, while one-third report never discussing drug-drug interactions despite 80% taking more than five medications, according to a survey conducted by Salix Pharmaceuticals in partnership with U.S. Pain Foundation.

Joseph Pergolizzi
Joseph Pergolizzi

“My colleagues at the U.S. Pain Foundation ... [will] tell you that we need to adopt a ‘do ask, do tell’ type of situation,” Joseph Pergolizzi, MD, senior partner and director of Analgesic Research at the Naples Anesthesia and Pain Associates in Southwest Florida, told Healio Gastroenterology and Liver Disease. “This is the most common adverse event associated with chronic opioid therapy — constipation related to the opioid — so it makes sense to have a conversation about that.”

The survey comprised 441 U.S. adults receiving opioid medications for chronic pain. Fifty-one percent reported experiencing opioid-induced constipation (OIC) for 3 years or longer, and 77% reported experiencing OIC for at least 1 year.

Medications not working fast enough was the greatest challenge, according to 73% of those surveyed. Patients reported that medications may take up to 18 hours on average to provide relief. Further, although 58% of patients reported feeling their doctors want to provide faster working medications for OIC relief, only 50% report initially receiving information from their doctor about constipation as a potential side effect.

“What we need to do, as doctors, is get a bowel habit list history [before opioid medication]. It’s important to have a fluid conduit of information,” Pergolizzi said.

Additionally, 32% reported that their doctor did not clarify potential adverse drug-to-drug interactions that may occur with multiple prescriptions and over-the-counter medications even though 80% of the survey participants reported taking five or more medications regularly and 20% reported taking more than 10 medications regularly.

Resorting to ‘avoidance techniques’

Of note, 37% of those surveyed reported changing or lowering the dosage of their opioid medication.

“What we should realize is that patients are going to do many things to try to mitigate unwanted side effects and it’s not uncommon for patients to use avoidance techniques, one of which may be changing their medication scheduling. This actually, in the most strict sense, would be considered misuse,” Pergolizzi said.

Pergolizzi added that when patients lower their prescribed dosage or change scheduling, they may experience more pain possibly leading to a patient to ‘double-up’ on their next dose.

“When you hear that patients are doing these trade-offs and trying to alleviate their pain or discomfort from OIC by changing the way they’re taking their medications as prescribed, this is a big concern. Chronic pain patients should not have to compromise one pain for another or compromise the potential efficacy of other medications they may be taking because of these limitations or side effects,” Pergolizzi concluded. – by Talitha Bennett

Disclosure: Pergolizzi reports he is a consultant for Salix Pharmaceuticals.

Editor's note: This article has been updated with a correction from a company representative.

Half of patients surveyed reported their physician did not discuss constipation as a side effect of opioid medication or did not recall such discussion, while one-third report never discussing drug-drug interactions despite 80% taking more than five medications, according to a survey conducted by Salix Pharmaceuticals in partnership with U.S. Pain Foundation.

Joseph Pergolizzi
Joseph Pergolizzi

“My colleagues at the U.S. Pain Foundation ... [will] tell you that we need to adopt a ‘do ask, do tell’ type of situation,” Joseph Pergolizzi, MD, senior partner and director of Analgesic Research at the Naples Anesthesia and Pain Associates in Southwest Florida, told Healio Gastroenterology and Liver Disease. “This is the most common adverse event associated with chronic opioid therapy — constipation related to the opioid — so it makes sense to have a conversation about that.”

The survey comprised 441 U.S. adults receiving opioid medications for chronic pain. Fifty-one percent reported experiencing opioid-induced constipation (OIC) for 3 years or longer, and 77% reported experiencing OIC for at least 1 year.

Medications not working fast enough was the greatest challenge, according to 73% of those surveyed. Patients reported that medications may take up to 18 hours on average to provide relief. Further, although 58% of patients reported feeling their doctors want to provide faster working medications for OIC relief, only 50% report initially receiving information from their doctor about constipation as a potential side effect.

“What we need to do, as doctors, is get a bowel habit list history [before opioid medication]. It’s important to have a fluid conduit of information,” Pergolizzi said.

Additionally, 32% reported that their doctor did not clarify potential adverse drug-to-drug interactions that may occur with multiple prescriptions and over-the-counter medications even though 80% of the survey participants reported taking five or more medications regularly and 20% reported taking more than 10 medications regularly.

Resorting to ‘avoidance techniques’

Of note, 37% of those surveyed reported changing or lowering the dosage of their opioid medication.

“What we should realize is that patients are going to do many things to try to mitigate unwanted side effects and it’s not uncommon for patients to use avoidance techniques, one of which may be changing their medication scheduling. This actually, in the most strict sense, would be considered misuse,” Pergolizzi said.

Pergolizzi added that when patients lower their prescribed dosage or change scheduling, they may experience more pain possibly leading to a patient to ‘double-up’ on their next dose.

“When you hear that patients are doing these trade-offs and trying to alleviate their pain or discomfort from OIC by changing the way they’re taking their medications as prescribed, this is a big concern. Chronic pain patients should not have to compromise one pain for another or compromise the potential efficacy of other medications they may be taking because of these limitations or side effects,” Pergolizzi concluded. – by Talitha Bennett

Disclosure: Pergolizzi reports he is a consultant for Salix Pharmaceuticals.

Editor's note: This article has been updated with a correction from a company representative.