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

doi:10.5055/jom.2015.0288

Authors

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

DOI:

https://doi.org/10.5055/jom.2015.0288

Keywords:

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

Abstract

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

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