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Do ask, do tell: Managing opioid-induced constipation amid the opioid epidemic
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Patients with chronic pain suffering from opioid-induced constipation, or OIC, report they often experience delayed diagnosis, and are largely unsatisfied with treatment for their constipation, according to national survey results reported by Salix Pharmaceuticals.
Healio Gastroenterology and Liver Disease recently spoke with Joseph Pergolizzi Jr., MD, senior partner at the Naples Anesthesia and Pain Associates Group of Southwest Florida, chairman of PAINWeek and spokesperson for the “Painstipation” survey. Below he discusses the results of this survey and a corresponding awareness initiative launched by Salix, as well as some tips for clinical gastroenterologists managing patients with OIC.
Healio: How common is OIC in the U.S.?
Pergolizzi: There are roughly 100 million Americans who suffer from chronic pain, many of whom may be treated with opioids. About 40% to 80% of those patients will experience OIC — it’s one of the most common side effects of opioid therapy.
Healio: What have you learned about patients with OIC based on these survey results?
Pergolizzi: We’ve learned that patients are waiting for relief. They go undiagnosed for too long, they’re not happy with their current constipation medication because it takes too long to have a bowel movement, and they’re really looking for rapid, reliable relief from OIC. We’ve also learned that pain is not only a medical issue; it’s a burden for many patients who are on many prescription medications to manage their conditions.
The survey found that more than half of (53%) of respondents prefer that their OIC medication relieve OIC in less than 4 hours. Most patients (73%) agree that one of the biggest challenges of having OIC is that medications don’t work quickly enough.
Healio: What are the goals of the new Salix campaign regarding this condition?
Pergolizzi: Painstipation, or the constipation caused by opioids, is really an initiative to increase awareness and encourage a dialogue between health care professionals and patients on the appropriate management of OIC.
Healio: What should clinical gastroenterologists know about treating these patients?
Pergolizzi: GI doctors need to know that this secondary pain — the constipation pain — is directly related to the opioid medications, and that these patients experience significant decrease in functional activities of daily living because of it. By having a “Do Ask, Do Tell” policy, meaning we’re asking our patients the right questions about their bowel habits after opioid therapy, and having a discussion about OIC, we can help to provide them with the rapid, reliable relief they’re looking for.
Healio: How can clinicians help guide patients with OIC in the decision to discontinue opioid treatment vs. considering an additional medication that can treat their OIC?
Pergolizzi: If a patient is on opioid therapy and has either experienced an adverse event or not achieved adequate pain control, the opioid regimen is a real opportunity to get meaningful improvement in pain and addressing related side effects, such as constipation. Again, I think managing expectations with patients that constipation following opioid therapy is likely to occur is a major step. When a patient tries to alleviate the OIC pain by altering their opioid therapy, they may experience suboptimal pain control so it’s really important to have an open dialogue with patients.
Healio: What role should a gastroenterologist play in identifying possible opioid abuse based on the presence of OIC?
Pergolizzi: GIs should be part of the multidisciplinary team that is treating patients on opioids and, therefore, realize that abuse, misuse and addiction are chief concerns related to opioid management.
Healio: How do you feel regulators’ and advocates’ work toward addressing the opioid abuse epidemic may intersect with OIC?
Pergolizzi: All sectors need to work together to navigate this sensitive issue. I believe that appropriate patient selection coupled with comprehensive opioid risk management plans, which include prescription database monitoring should be incorporated into a patient’s pain management plan, which also addresses common side effects like OIC.
Disclosures: Pergolizzi reports he is a paid spokesperson for Salix Pharmaceuticals.