When People with OpioidInduced Constipation Speak

Authors: Robert S Epstein J Russell Teagarden Ali Cimen Mark Sostek Tehseen Salimi

Publish Date: 2017/02/08

Volume: 34, Issue: 3, Pages: 725-731

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Abstract

Opioidinduced constipation OIC is a common consequence of opioid use for chronic pain OIC creates problems for patients independent of their pain syndromes in addition to threatening pain treatment effectiveness Healthcare practitioners need to be alert to how patients talk about OIC so that it is not missed Using a survey mechanism we sought patient expressions of the personal impact OIC imposes on how they are able to live their lives and on meanings that symptom relief would produceWe used an online survey asking adults with OIC about quality of life implications of OIC and focused on openended text responses to questions about personal impacts of straining and meanings attached to OIC symptom relief Participants were from the US Canada UK Germany Sweden and NorwayA survey of 513 people with OIC produced 280 text responses concerning the impacts of straining on quality of life and 469 text responses on the meaning OIC symptom relief would confer Text responses about the quality of life impacts of straining often included explicit descriptions conveying physical psychological or practical problems Text responses about the meaning conferred from OIC symptom relief primarily concentrated around freedom from the constraints that OIC can imposePatients are willing and able to comment on the problems OIC cause them using a variety of terms and phrases Their comments concerning impacts on their lives will often refer to physical consequences psychological effects or practical implications These insights provide healthcare practitioners guidance on how to engage patients about OICElizabeth Scarry famously framed a predicament many people with chronic pain find themselves in as “to have great pain is to have certainty to hear that another person has pain is to have doubt” 1 People with chronic pain are thus often haunted by the prospect that those who they depend upon for treatment support and empathy may not believe them Their predicament extends further when they need these others—including healthcare practitioners—to believe that the drugs they take for pain also cause them particular problems such as opioidinduced constipation OICOIC is characterized by a change from baseline bowel habits when initiating opioid therapy and specifically comprises reduced bowel movement frequency development or worsening of straining to pass bowel movements and a sense of incomplete rectal evacuation or harder stool consistency 2 Incidence rates have ranged from 41 across clinical trials involving noncancer patients 3 to 62 in a survey of patients across several cancer clinics 4 and to 86 of cancer and noncancer patients drawn from the National Health and Wellness Survey 5 Many efforts have been directed at discerning the effects and impact of OIC We know OIC causes physical problems 4 5 6 7 along with anxiety distress and fear among other psychological effects 4 7 8 We know it interferes with activities of daily living diminishes quality of life and intrudes upon family interactions 4 5 6 We even know that OIC often upends the efforts of patients to comply with pain management treatment plans and results in higher utilization of healthcare resources 3 4 5 6 7 8 9 Not known nearly as well is how patients verbally express the personal effects and impacts of OIC Knowing how patients verbalize OIC problems as they affect their lives could help clinicians identify new cases educate those initiating opioid therapy and assess cases already under treatmentWe sought verbatim responses from patients with OIC about how the difficulties of bowel movements affect their quality of life and about the importance they attach to experiencing complete bowel movements These verbatim responses were recorded as part of a larger survey concerned with the OIC symptoms patients would most like addressed and the minimal clinically important difference in treating this condition The findings of that aspect of the survey have since been published 10 We report here the findings from the verbatim responses collected from the survey

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