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

Abstract

OBJECTIVE:

This analysis of patient-health care provider discussions of opioid-induced constipation (OIC) evaluated the dynamics of interactions, identified communication gaps, and assessed the functional burden of opioid-induced constipation on patients' lives.

DESIGN:

Retrospective analysis of a Health Insurance Portability and Accountability Act-compliant database of >120,000 patient-provider conversations.

SETTING:

Outpatient offices in the United States.

METHODS:

Conversations between providers and patients prescribed opioids that occurred in the United States (January 2014-May 2016) and included a discussion of opioid-induced constipation were identified. Demographics and prespecified opioid-induced constipation conversation characteristics were evaluated for these conversations.

RESULTS:

This analysis included 216 patient-provider discussions. Most patients (76.4% [165/216]) were ≥50 years old. Most conversations were with pain management specialists (39.8% [86/216]) or primary care physicians (36.6% [79/216]). Overall, 64.4% (139/216) of patients reported experiencing symptoms of constipation. Health care providers indicated that symptoms of constipation could be caused by opioid use for 75.5% (105/139) of patients with constipation. In most cases (82.4% [178/216]), providers did not probe about specific constipation symptoms. Few patients (11.5% [16/139]) with OIC discussed the burden of OIC with their providers; burdens reported by patients with OIC included emergency room visits and reduced food or fluid intake. No specific action was recommended for 33.8% (47/139) of patients with constipation.

CONCLUSIONS:

In this analysis, when opioid-induced constipation was discussed, health care providers did not inquire about specific symptoms for most patients, opioids were not cited as a cause of constipation in approximately one-quarter of patients with opioid-induced constipation, and no clear treatment plan or guidance was recommended for one-third of patients. Results of this analysis suggest that more education may be needed to improve patient-provider communication about opioid-induced constipation.

• Authors: April Hazard Vallerand, Sarah Hendry, Elizabeth Baldys, Yiqun Hu, Catherine Datto
• Journal: Pain medicine (Malden, Mass.) (Pain Med) Vol. 20 Issue 5 Pg. 889-896 (05 01 2019) ISSN: 1526-4637 [Electronic] England
• PMID: 30125008 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Analgesics, Opioid

Topics

• Adult
• Analgesics, Opioid (adverse effects)
• Chronic Pain (drug therapy)
• Cost of Illness
• Female
• Humans
• Male
• Middle Aged
• Opioid-Induced Constipation
• Professional-Patient Relations
• United States