Balancing opioid-induced gastrointestinal side effects with pain management: Insights from the online community


  • Cynthia B. Whitman, MPH
  • Mark W. Reid, PhD
  • Corey Arnold, PhD
  • Lyann Ursos, PhD
  • Roee Sa’adon, MS
  • Jonathan Pourmorady, MD
  • Brennan M. R. Spiegel, MD, MSHS
  • Haridarshan Patel, PharmD



social media, opioid-induced constipation, pain management, doctor-patient communication


Opioids cause gastrointestinal (GI) symptoms such as nausea, vomiting, pain, and (in 40 percent) constipation that diminish patients’ quality of life. Outside traditional surveys, little is known about the opioid-induced constipation (OIC) patient experience and its impact on pain management. The purpose of this study was to use data from social media platforms to qualitatively examine patient beliefs about OIC and other prominent GI side effects, their impact on effective pain management and doctor-patient interaction. The authors collected Tweets from March 25 to July 31, 2014, and e-forum posts from health-related social networking sites regardless of timestamp. The authors identified specific keywords related to opioids and GI side effects to locate relevant content in the dataset, which was then manually coded using ATLAS.ti software. The authors examined 2,519,868 Tweets and more than 1.8 billion e-forum posts, of which, 88,586 Tweets and 9,767 posts satisfied the search criteria. Three thousand three individuals experienced opioid-induced GI side effects, mostly related to phenanthrenes (n = 1,589), and 1,274 (42.4 percent) individuals described constipation. Over-the-counter medications and nonevidence-based natural approaches were most commonly used to alleviate constipation. Many individuals questioned, rotated, reduced, or stopped their opioid treatments as a result of their GI side effects. Investigation of social media reveals a struggle to balance pain management with opioid-induced GI side effects, especially constipation. Individuals are often unprepared to treat OIC, to modify opioid regiments without medical advice, and to resort to using natural remedies and treatments lacking scientific evidence of effectiveness. These results identify opportunities to improve physician-patient communication and explore effective treatment alternatives.

Author Biographies

Cynthia B. Whitman, MPH

Clinical Research Coordinator, Cedars-Sinai Health System, Principal Research Coordinator, Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.

Mark W. Reid, PhD

Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California

Corey Arnold, PhD

Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California. Haridarshan Patel, PharmD, Immensity Consulting, Inc., Chicago, Illinois

Lyann Ursos, PhD

Scientific Associate Director, Takeda Pharmaceuticals International, Inc., Deerfield, Illinois

Roee Sa’adon, MS

Vice President, Technology, Treato Ltd., Or Yehuda, Israel.

Jonathan Pourmorady, MD

Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California

Brennan M. R. Spiegel, MD, MSHS

Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.


Haridarshan Patel, PharmD

Immensity Consulting, Inc., Chicago, Illinois


Breivik H, Collett B, Ventafridda V, et al.: Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment.

Eur J Pain. 2006; 10(4): 287-333.

Blyth FM, March LM, Brnabic AJ, et al.: Chronic pain in Australia: A prevalence study. Pain. 2001; 89(2-3): 127-134.

Verhaak PF, Kerssens JJ, Dekker J, et al.: Prevalence of chronic benign pain disorder among adults: A review of the literature. Pain. 1998; 77(3): 231-239.

Sullivan MD, Edlund MJ, Fan MY, et al.: Trends in use of opioids for non-cancer pain conditions 2000–2005 in commercial and Medicaid insurance plans: The TROUP study. Pain. 2008; 138(2): 440-449.

Rosenblatt RA, Catlin M: Opioids for chronic pain: First do no harm. Ann Fam Med. 2012; 10(4): 300-301.

Panchal SJ, Muller-Schwefe P, Wurzelmann JI: Opioid-induced bowel dysfunction: Prevalence, pathophysiology and burden. Int J Clin Pract. 2007; 61(7): 181-187.

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.

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.

Allan L, Hays H, Jensen N-H, 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.

Tuteja AK, Biskupiak J, Stoddard GJ, et al.: Opioid-induced bowel disorders and narcotic bowel syndrome in patients with chronic non-cancer pain. Neurogastroenterol Motil. 2010; 22(4): 424-430, e96.

Bell T, 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.

Coyne KS, LoCasale RJ, Datto CJ, et al.: Opioid-induced constipation in patients with chronic noncancer pain in the USA, Canada, Germany, and the UK: Descriptive analysis of baseline patient-reported outcomes and retrospective chart review. Clinicoecon Outcomes Res. 2014; 6: 269-281.

Fallon MT: Constipation in cancer patients: Prevalence, pathogenesis and cost-related issues. Eur J Pain. 1999; 3: 3-7.

Coyne KS, Currie BM, Holmes WC, et al.: Assessment of a stool symptom screener and understanding the opioid-induced constipation symptom experience. Patient. 2015; 8(4): 317-327.

Chancellor J, Martin M, Liedgens H, et al.: Stated preferences of physicians and chronic pain sufferers in the use of classic strong opioids. Value Health. 2012; 15(1): 106-117.

Upshur CC, Bacigalupe G, Luckmann R: “They don't want anything to do with you”: Patient views of primary care management of chronic pain. Pain Med. 2010; 11(12): 1791-1798.

Wallace LS, Wexler RK, McDougle L, et al.: Voices that may not otherwise be heard: A qualitative exploration into the perspectives of primary care patients living with chronic pain. J Pain Res. 2014; 7: 291-299.

Golder SA, Macy MW: Diurnal and seasonal mood vary with work, sleep, and day-length across diverse cultures. Science. 2011; 333(6051): 1878-1881.

Thaker SI, Nowacki AS, Mehta NB, et al.: How U.S. hospitals use social media. Ann Intern Med. 2011; 154(10): 707-708.

Weitzman ER, Adida B, Kelemen S, et al.: Sharing data for public health research by members of an international online diabetes social network. PLoS One. 2011; 6(4): e19256.

Wicks P, Vaughan TE, Massagli MP, et al.: Accelerated clinical discovery using self-reported patient data collected online and a patient-matching algorithm. Nat Biotechnol. 2011; 29(5): 411-414.

St Louis C, Zorlu G: Can Twitter predict disease outbreaks? BMJ. 2012; 344: e2353.

Nascimento TD, DosSantos MF, Danciu T, et al.: Real-time sharing and expression of migraine headache suffering on Twitter: A cross-sectional infodemiology study. J Med Internet Res. 2014; 16(4): e96.

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.



How to Cite

Whitman, MPH, C. B., M. W. Reid, PhD, C. Arnold, PhD, L. Ursos, PhD, R. Sa’adon, MS, J. Pourmorady, MD, B. M. R. Spiegel, MD, MSHS, and H. Patel, PharmD. “Balancing Opioid-Induced Gastrointestinal Side Effects With Pain Management: Insights from the Online Community”. Journal of Opioid Management, vol. 11, no. 5, Sept. 2015, pp. 383-91, doi:10.5055/jom.2015.0288.