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

• Published in: Pain medicine (Malden, Mass.) Mass.), 2019-05, Vol.20 (5), p.889-896
• Main Authors: Vallerand, April Hazard, Hendry, Sarah, Baldys, Elizabeth, Hu, Yiqun, Datto, Catherine
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid - adverse effects; Analysis; Chronic pain; Chronic Pain - drug therapy; Complications and side effects; Constipation; Cost of Illness; Demography; Drug therapy; Emergency medical care; Female; Fluid intake; Food intake; Humans; Male; Middle Aged; Narcotics; Opioid-Induced Constipation; Opioids; Pain; Pain management; Patients; Physician and patient; Primary care; Professional-Patient Relations; Risk factors; United States; Verbal communication
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pny151

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.