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

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

doi:10.5055/jom.2015.0282

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.

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