Attitude of Swiss physicians towards opioid-induced constipation: A national survey

Abstract

Background Opioid-induced constipation is a severe complication affecting up to 90% of chronic pain patients treated with opioids, causing considerable suffering and non-adherence to treatment. Objective To examine the attitude of Swiss practising physicians towards opioid-induced constipation awareness and management. Methods A total of 961 Swiss practising physicians were surveyed by questionnaire concerning their experience of and perspective on the prevalence and symptoms of opioid-induced constipation, time of development, treatment, impact on quality of life (QoL) and adherence to opioid treatment. Chronic constipation was defined following the Rome III diagnostic criteria for functional gastrointestinal disorders. Results Physicians stated that in their experience 62.4% (range 4–100%) of patients treated with opioids developed opioid-induced constipation and 82.4% of physicians observed it within the first week of opioid administration. Dry and/or hard stools were reported by 78.5% of physicians as the most prevalent observed symptom of opioid-induced constipation, 71.2% of physicians experienced a negative impact of opioid-induced constipation on the QoL of patients and 70.7% believed that opioid-induced constipation negatively affected patients’ treatment adherence. Perceived efficacy was judged by 91.4% of physicians to be a highly relevant aspect of opioid therapy, whereas only 22.1% rated therapy costs as highly relevant. Conclusion Swiss physicians consider opioid-induced constipation to be a major and early developing adverse effect of opioid therapy that negatively affects QoL and treatment adherence. To avoid opioid-induced constipation, administration of laxatives or a combination of opioids with receptor antagonists must be considered as preventive measures.