Analysis of Patient-Provider Interactions Regarding the Burden and Treatment of Opioid-Induced Constipation in Adults with Chronic Noncancer Pain.

Abstract

This analysis of patient-health care provider discussions of opioid-induced constipation (OIC) evaluated the dynamics of interactions, identified communication gaps, and assessed the functional burden of opioid-induced constipation on patients' lives. Retrospective analysis of a Health Insurance Portability and Accountability Act-compliant database of >120,000 patient-provider conversations. Outpatient offices in the United States. Conversations between providers and patients prescribed opioids that occurred in the United States (January 2014-May 2016) and included a discussion of opioid-induced constipation were identified. Demographics and prespecified opioid-induced constipation conversation characteristics were evaluated for these conversations. This analysis included 216 patient-provider discussions. Most patients (76.4% [165/216]) were ≥50 years old. Most conversations were with pain management specialists (39.8% [86/216]) or primary care physicians (36.6% [79/216]). Overall, 64.4% (139/216) of patients reported experiencing symptoms of constipation. Health care providers indicated that symptoms of constipation could be caused by opioid use for 75.5% (105/139) of patients with constipation. In most cases (82.4% [178/216]), providers did not probe about specific constipation symptoms. Few patients (11.5% [16/139]) with OIC discussed the burden of OIC with their providers; burdens reported by patients with OIC included emergency room visits and reduced food or fluid intake. No specific action was recommended for 33.8% (47/139) of patients with constipation. In this analysis, when opioid-induced constipation was discussed, health care providers did not inquire about specific symptoms for most patients, opioids were not cited as a cause of constipation in approximately one-quarter of patients with opioid-induced constipation, and no clear treatment plan or guidance was recommended for one-third of patients. Results of this analysis suggest that more education may be needed to improve patient-provider communication about opioid-induced constipation.