Impact of constipation on opioid therapy management among long-term opioid users, based on a patient survey

Authors

  • Shaloo Gupta, MS
  • Haridarshan Patel, PharmD
  • Justin Scopel, MD, MBA
  • Reema R. Mody, MBA, PhD

DOI:

https://doi.org/10.5055/jom.2015.0282

Keywords:

health-related quality of life, opioid-induced constipation, pain management, productivity, treatment adherence

Abstract

Objective: The authors sought to characterize health-related quality of life (HRQoL), medication adherence, productivity losses, and treatment satisfaction associated with modifications to opioid therapy due to opioid-induced constipation (OIC).

Design: A cross-sectional, between-subjects design was used to examine health outcomes among US noncancer participants currently taking opioids.

Patients, participants: Participants were adults in the 2012 US National Health and Wellness Survey, who reported currently using opioids (>30 days) and experiencing constipation. Respondents were categorized as making modifications to opioid therapy due to OIC (modifiers, n = 244) or making no modifications (nonmodifiers, n = 247).

Main outcome measures: Patient Assessment of Constipation Quality of Life (PAC-QoL) and Symptoms (PAC-Sym), Morisky Medication Adherence Scale (MMAS-4), Work Productivity and Activity Impairment, and the Treatment Satisfaction Questionnaire for Medication (TSQM II) for OIC treatment were administered. Generalized linear models were adjusted to control for baseline characteristics (age, gender, comorbidities, opioid strength, etc). Results: Modifiers reported poorer HRQoL (PAC-QoL total: 1.74 vs 1.44, p < 0.001), worse constipation (PAC-Sym total: 1.56 vs 1.35, p = 0.003), more pain-related resource use (surgery: odds ratio (OR) = 3.72, p = 0.002; emergency room visits: OR = 1.88, p = 0.049; hospitalizations: OR = 2.47, p = 0.033), and lower adherence (MMAS-4 pain: OR = 0.12, p < 0.001; MMAS-4 OIC: OR = 0.39, p < 0.001) than nonmodifiers. Modifiers reported greater presenteeism (49.75 percent vs 38.28 percent, p = 0.038), but no significant differences were found for activity impairment or OIC treatment satisfaction.

Conclusions: Treating OIC effectively may help prevent inadequate pain management secondary to opioid therapy modification, help increase HRQoL, lessen OIC symptoms, decrease productivity loss, and improve adherence to opioid and OIC treatments.

Author Biographies

Shaloo Gupta, MS

Health Outcomes Practice, Kantar Health, Princeton, New Jersey

Haridarshan Patel, PharmD

Consultant, Immensity Consulting, Inc., Chicago, Illinois

Justin Scopel, MD, MBA

US Medical Affairs, Takeda Pharmaceuticals International, Inc., Deerfield, Illinois.

Reema R. Mody, MBA, PhD

Global Outcomes Research Department, Takeda Pharmaceuticals International, Inc., Deerfield, Illinois.

References

Benyamin R, Trescot AM, Datta S, et al.: Opioid complications and side effects. Pain Physician. 2008; 11(2 suppl): S105-S120.

Kalso E, Edwards JE, Moore RA, et al.: Opioids in chronic non-cancer pain: Systematic review of efficacy and safety. Pain. 2004; 112(3): 372-380.

Bell TJ, Panchal SJ, Miaskowski C, et al.: The prevalence, severity, and impact of opioid-induced bowel dysfunction: Results of a US and European patient survey (PROBE 1). Pain Med. 2009; 10(1): 35-42.

Bell TJ, Annunziata K, Leslie JB: Opioid-induced constipation negatively impacts pain management, productivity, and health-related quality of life: Findings from the National Health and Wellness Survey. J Opioid Manag. 2009; 5(3): 137-144.

Allan L, Hays H, Jensen NH, et al.: Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain. BMJ. 2001; 322(7295): 1154-1158.

Moore RA, McQuay HJ: Prevalence of opioid adverse events in chronic non-malignant pain: Systematic review of randomized trials of oral opioids. Arthritis Res Ther. 2005; 7(5): R1046-R1051.

McMillan SC: Assessing and managing opiate-induced constipation in adults with cancer. Cancer Control. 2004; 11(3 suppl): 3-9.

Meuser T, Pietruck C, Radbruch L, et al.: Symptoms during cancer pain treatment following WHO-guidelines: A longitudinal

follow-up study of symptom prevalence, severity and etiology. Pain. 2001; 93(3): 247-257.

Williams RE, Bosnic N, Sweeney CT, et al.: Prevalence of opioid dispensings and concurrent gastrointestinal medications in Quebec. Pain Res Manage. 2008; 13(5): 395-400.

Claxton AJ, Cramer J, Pierce C: A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001; 23(8): 1296-1310.

Richter A, Anton SE, Koch P, et al.: The impact of reducing dose frequency on health outcomes. Clin Ther. 2003; 25(8): 2307-2335.

Ballantyne JC: Opioid analgesia: Perspectives on right use and utility. Pain Physician. 2007; 10(3): 479-491.

Martell BA, O’Connor PG, Kerns RD, et al.: Systematic review: Opioid treatment for chronic back pain: Prevalence, efficacy, and association with addiction. Ann Intern Med. 2007; 146(2): 116-127.

Mao J: Opioid-induced abnormal pain sensitivity: Implications in clinical opioid therapy. Pain. 2002; 100(3): 213-217.

Ketwaroo GA, Cheng V, Lembo A: Opioid-induced bowel dysfunction. Curr Gastroenterol Rep. 2013; 15(9): 344.

Charlson M, Szatrowski TP, Peterson J, et al.: Validation of a combined comorbidity index. J Clin Epidemiol. 1994; 47(11): 1245-1251.

Marquis P, De La Loge C, Dubois D, et al.: Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol. 2005; 40(5): 540-551.

Frank L, Kleinman L, Farup C, et al.: Psychometric validation of a constipation symptom assessment questionnaire. Scand J Gastroenterol. 1999; 34(9): 870-877.

Slappendel R, Simpson K, Dubois D, et al.: Validation of the PAC-SYM questionnaire for opioid-induced constipation in patients with chronic low back pain. Eur J Pain. 2006; 10(3): 209-217.

Reilly MC, Zbrozek AS, Dukes EM: The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993; 4(5): 353-365.

Morisky DE, Ang A, Krousel-Wood M, et al.: Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008; 10(5): 348-354.

Atkinson MJ, Kumar R, Cappelleri JC, et al.: Hierarchical construct validity of the Treatment Satisfaction Questionnaire for Medication (TSQM version II) among outpatient pharmacy consumers. Value Health. 2005; 8(suppl 1): S9-S24.

Kwong WJ, Diels J, Kavanagh S: Costs of gastrointestinal events after outpatient opioid treatment for non-cancer pain. Ann Pharmacother. 2010; 44(4): 630-640.

Candrilli SD, Davis KL, Iyer S: Impact of constipation on opioid use patterns, health care resource utilization, and costs in cancer patients on opioid therapy. J Pain Palliat Care Pharmacother. 2009; 23(3): 231-241.

Leslie J, Bell T, Annunziata K, et al.: Opioid-induced constipation compromises pain management and impacts patient quality of life (abstract A1490). Anesthesiology. 2006; 105: A1490.

Hjalte F, Berggren AC, Bergendahl H, et al.: The direct and indirect costs of opioid-induced constipation. J Pain Symptom Manage. 2010; 40(5): 696-703.

Takemoto ML, Fernandes RA, Almeida GR, et al.: Health care resource use and costs in opioid-treated patients with and without constipation in Brazil. Value Health. 2011; 14(5 suppl 1): S78-S81.

Abramowitz L, Béziaud N, Labreze L, et al.: Prevalence and impact of constipation and bowel dysfunction induced by strong opioids: A cross-sectional survey of 520 patients with cancer pain: DYONISOS study. J Med Econ. 2013; 16(12): 1423-1433.

Thorpe DM: Management of opioid-induced constipation. Curr Pain Headache Rep. 2001; 5(3): 237-240.

Wong BS, Camilleri M: Lubiprostone for the treatment of opioid-induced bowel dysfunction. Expert Opin Pharmacother. 2011; 12(6): 983-990.

Kumar L, Barker C, Emmanuel A: Opioid-induced constipation: Pathophysiology, clinical consequences, and management. Gastroenterol Res Pract. 2014; 2014: 141737.

Leppert W. The impact of opioid analgesics on the gastrointestinal tract function and the current management possibilities. Contemp Oncol (Pozn). 2012; 16(2): 125-131.

Dhingra L, Shuk E, Grossman B, et al.: A qualitative study to explore psychological distress and illness burden associated with opioid-induced constipation in cancer patients with advanced disease. Palliat Med. 2013; 27: 447-456.

Published

07/01/2015

How to Cite

Gupta, MS, S., H. Patel, PharmD, J. Scopel, MD, MBA, and R. R. Mody, MBA, PhD. “Impact of Constipation on Opioid Therapy Management Among Long-Term Opioid Users, Based on a Patient Survey”. Journal of Opioid Management, vol. 11, no. 4, July 2015, pp. 325-38, doi:10.5055/jom.2015.0282.